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

Authors

• Sopan Lahewala, Department of Medicine, Robert Wood Johnson - Barnabas Health, Jersey City, NJ, United States of America.
• Shilpkumar Arora, Department of Cardiology, Mount Sinai St Luke's Roosevelt Hospital, New York, NY, United States of America. Electronic address: dr.shilparora@yahoo.com.
• Byomesh Tripathi, Department of Cardiology, Mount Sinai St Luke's Roosevelt Hospital, New York, NY, United States of America.
• Sidakpal Panaich, Department of Interventional Cardiology/Structural Heart Disease, University of Iowa, United States of America.
• Varun Kumar, Department of Cardiology, Mount Sinai St Luke's Roosevelt Hospital, New York, NY, United States of America.
• Nirali Patel, Department of Cardiology, University of Southern California, California, LA, United States of America.
• Sejal Savani, Department of Cardiology, Mount Sinai St Luke's Roosevelt Hospital, New York, NY, United States of America.
• Mihir Dave, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
• Yash Varma, Department of Medicine, Guthrie Hospital, Sayre, PA, United States of America.
• Apurva Badheka, Department of Cardiology, The Everett Clinic, Everett, WA, United States of America.
• Abhishek Deshmukh, Department of Cardiology, Mayo Clinic, Rochester, MN, United States of America.
• Umesh Gidwani, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
• Radha Gopalan, Department of Cardiology, University of Arizona College of Medicine, Phoenix, AZ, United States of America.
• Alexandros Briasoulis, Department of Interventional Cardiology/Structural Heart Disease, University of Iowa, United States of America.

Document Type

Article

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.

Medical Subject Headings

Adolescent; Adult; Aged; Aged, 80 and over; Female; Heart Failure (economics, mortality, therapy); Hospital Mortality (trends); Humans; Length of Stay (trends); Male; Middle Aged; Patient Readmission (economics, trends); Risk Factors; Treatment Outcome; Young Adult

Publication Date

3-1-2019

Publication Title

International journal of cardiology

E-ISSN

1874-1754

Volume

278

First Page

186

Last Page

191

PubMed ID

30579719

Digital Object Identifier (DOI)

10.1016/j.ijcard.2018.12.043

Recommended Citation

Lahewala, Sopan; Arora, Shilpkumar; Tripathi, Byomesh; Panaich, Sidakpal; Kumar, Varun; Patel, Nirali; Savani, Sejal; Dave, Mihir; Varma, Yash; Badheka, Apurva; Deshmukh, Abhishek; Gidwani, Umesh; Gopalan, Radha; and Briasoulis, Alexandros, "Heart failure: Same-hospital vs. different-hospital readmission outcomes" (2019). Neurology. 2073.
https://scholar.barrowneuro.org/neurology/2073