Objective: Evaluate trends in readmission and mortality rates after heart failure (HF) hospitalization among veterans in the era of improved utilization of guideline directed therapy and nation-wide focus on decreasing hospital readmission rates.
Background: In the past decade, a strong emphasis has been placed on decreasing HF readmissions. Concurrently, adherence to guideline directed therapy has improved. A 2002 to 2006 evaluation of the Veterans Affairs Health Care System (VAHCS) showed stagnant HF readmission rates, but declining mortality rates. It is unclear to what extent the recent focus on decreasing readmission and following guidelines has affected these outcomes.
Methods: The 30-day mortality and 30-day readmission rates of patients admitted with a first diagnosis of HF from 2006 to 2013 in the VAHCS were assessed for temporal trends. Odds ratios for these outcomes were adjusted for patient demographics, medical history, and laboratory data.
Results: This study included 119,261 patients admitted to VAHCS institutions between 2006 and 2013 with a new diagnosis of HF. Among these patients, 116,849 were male, the mean age was 71.1 years, 80,497 were white, 24,753 were black, and 6,548 were Hispanic. During the two years preceding admission, the incidence of renal disease, ischemic heart disease, diabetes, malignancy, hypertension, COPD, CVD, and acute myocardial infarction were 46.1% (54,984 of 119,261), 73.5% (87,640 of 119,261), 56.1% (66,883 of 119,261), 16.2% (19,257 of 119,261), 92.8% (110,687 of 119,261), 53.7% (64,064 of 119,261), 22.9% (27,268 of 119,261), and 26.5% (31,619 of 119,261), respectively. During the study period, the 30-day readmission rate declined from 19.56% (3852 of 19,694) to 13.76% (1420 of 10,317, p < 0.0001) with an adjusted odds ratio of 30-day readmission in 2013 (vs 2006) of 0.66 (95% CI: 0.66 to 0.76) (Figure 1). Conversely, the 30-day mortality rate was stable at 5.62% (1107 of 19,694) in 2006 and 5.30% (547 of 10,317) in 2013 (p = 0.45) with an adjusted odds ratio of 30-day mortality in 2013 (vs 2006) of 1.22 (95% CI: 1.09 to 1.37). This odds ratio was stable from 2007 through 2013.
Conclusions: Despite the observed decline in 30-day readmission rates, 30-day mortality rates have been unaffected by the recent focus on preventing readmission and improved guideline adherence.