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30-day readmission linked to mortality risk in Medicare patients with HF
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Medicare-eligible patients hospitalized for HF had greater risk for all-cause mortality if they were readmitted within 30 days, according to new findings.
During nearly 9 years, those who were readmitted within 30 days also had more all-cause readmissions, a longer cumulative length of stay and a higher cumulative cost burden vs. those who were not readmitted within 30 days, researchers reported.
Cherinne Arundel, MD, from the Veterans Affairs Medical Center in Washington, D.C., and colleagues analyzed 7,578 Medicare beneficiaries with HF discharged from 106 Alabama hospitals between 1998 and 2001.
Of that cohort, 1,519 were readmitted within 30 days for any cause. Using propensity scores based on 34 characteristics, Arundel and colleagues matched 1,516 pairs of patients (mean age, 75 years; 56% women; 24% black), each pair including one patient with 30-day readmission and one without.
Between months 2 and 12, among the matched patients, 41% of those who were readmitted within 30 days died vs. 27% of those who were not (HR = 1.68; 95% CI, 1.48-1.9), Arundel and colleagues wrote.
During 8.7 years of follow-up (mean, 3.1 years), 30-day readmission remained associated with all-cause mortality (HR = 1.33; 95% CI, 1.22-1.45), the researchers wrote.
During the full study period, compared with those without it, those with 30-day readmission had more all-cause readmissions (6.9 vs. 5.1; P < .001), more readmissions for HF (2.4 vs. 1.7; P < .001), a longer mean cumulative length of stay (51 days vs. 43 days; P < .001) and a higher mean cumulative cost burden ($38,972 vs. $34,025; P = .001).
Ninety-day all-cause readmission also conferred increased risk for all-cause mortality at 12 months (30% vs. 19%; HR = 1.7; 95% CI, 1.51-1.91) and at 8.7 years (HR = 1.29; 95% CI, 1.2-1.38), according to the researchers.
“For a hidden covariate to explain away our primary association, it would need to be a near-perfect predictor of 2- to 12-month all-cause mortality and would also need to increase the odds of having a 30-day all-cause readmission by 50%, which is an unlikely possibility,” Arundel and colleagues wrote. – by Erik Swain
Disclosure : The researchers report no relevant financial disclosures.
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