Heart failure: Same-hospital vs. different-hospital readmission outcomes

Sopan Lahewala, Shilpkumar Arora, Byomesh Tripathi, Sidakpal Panaich, Varun Kumar, Nirali Patel, Sejal Savani, Mihir Dave, Yash Varma, Apurva Badheka, Abhishek Deshmukh, Umesh Gidwani, Radha Gopalan, Alexandros Briasoulis

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Background: Heart Failure (HF) is a major driver of the readmissions/penalties in the US. Although extensive literature on rehospitalization attributed to HF, studies to compare outcomes for same-hospital vs. different-hospital readmissions are sparse. Methods: Nationwide Readmission Database from 2010 to 14 utilized for HF-related hospitalization using appropriate ICD-9-CM diagnostic codes. 30-day readmissions were classified into two groups: same-hospital and different-hospital. A comparative analysis was conducted focusing on: in-hospital mortality, length of stay (LOS) and hospitalization cost. Hierarchical two-level modeling and propensity score matching utilized to adjust confounders. Results: 715,993 HF readmissions were identified, of which 21.3% were readmitted to different-hospital. Elderly, females, patients with higher co-morbidities and higher median household income were less likely to be readmitted to different-hospital. Index hospitalizations in a teaching hospital and/or larger hospital were associated with reduced different-hospital readmissions. Readmissions to the different hospital were associated with higher in-hospital mortality (7.7% vs. 6.6%, p < 0.001), higher resource utilization (LOS:7.5 days vs. 6.1 days, p < 0.001 and Cost: $22,602 vs. $13,740, p < 0.001) after adjusting for propensity score match. Similar results were observed with propensity score matching of multiple high-risk subgroups. Conclusion: Resources should be directed towards minimizing different-hospital HF readmissions to improve patient outcomes by identifying the vulnerable subgroup and further tailoring in-hospital and post-discharge care.

Original languageEnglish
Pages (from-to)186-191
Number of pages6
JournalInternational Journal of Cardiology
Volume278
DOIs
StatePublished - 1 Mar 2019

Keywords

  • Cost
  • Heart failure
  • Length of stay
  • Mortality
  • Readmission

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