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Readmission to original hospital confers better outcomes in patients with HF
Patients with HF who are readmitted to the same hospital had improved outcomes compared with those admitted to a different hospital, according to a study in the Journal of the American Heart Association.
“[Admission to the nearest hospital] makes sense in time-sensitive acute conditions where delays in initial treatment are associated with poorer outcomes — thus the adage ‘time is muscle’ for [MIs] and ‘time is brain’ for strokes,” Finlay A. McAlister, MD, MSc, professor of general internal medicine at the University of Alberta in Edmonton, said in a press release. “[HF] is a chronic condition, and continuity of care seems to be more important.”
Researchers analyzed data from 217,039 patients (mean age, 77 years; 50% men) with HF who were admitted and discharged between April 2004 and December 2013. Patients who were younger than 20 years, hospitalized for longer than 30 days or readmitted within 24 hours were excluded from the study.
The primary outcomes were in-hospital mortality and length of stay for patients admitted to the original hospital vs. a different hospital.
Of the 39,368 patients who were readmitted within 30 days, 32,771 patients (83.2%) went to the original hospital and 6,597 patients (16.8%) were admitted to a different hospital. The rate of readmission to a different hospital increased from 2004 (15.6%) to 2013 (18.5%; P for trend = .001). Readmission to the same hospital was more likely for patients if they were older women, had a shorter length of stay during the original hospitalization, lived in an urban area, were treated at a community hospital and had fewer comorbidity issues, as well as if the attending physician during the initial hospitalization was a primary care physician.
The length of stay for patients readmitted to the original hospital was shorter (mean, 10.4 days; 95% CI, 10.3-10.6; adjusted mean, 11 days; 95% CI, 10.1-12) vs. those admitted to a different hospital (mean, 11.6 days; 95% CI, 11.3-12; adjusted mean, 12 days; 95% CI, 11.1-13; P < .0001). Those readmitted to the same hospital also had lower mortality rates (14.4%) compared with those admitted to a different hospital (15%; adjusted OR = 0.89; 95% CI, 0.82-0.96).
“We believe our study provides further support for the importance of continuity in health care and should motive patients, caregivers and their physicians to ensure follow-up after discharge occurs with health care providers who are familiar with them,” McAlister and colleagues wrote. “Our study should also motivate health system planners to conduct evaluations of ‘return to original hospital’ vs. ‘take to the closest facility’ ambulance policies for HF patients who deteriorate postdischarge.” – by Darlene Dobkowski
Disclosure: The researchers report no relevant financial disclosures.