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Length of stay for Medicare patients hospitalized for heart failure decreases but readmission rates rise, 14-year data reveal

Tuesday, July 13 2010 | Comments

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What's This? During a 14-year period, the length of hospital stay and 30-day mortality for patients with heart failure (HF) declined but posthospital readmission rates increased, a recent study showed.
 
The observational study identified 6,955,461 Medicare fee-for-service hospitalizations for patients aged 65 years or older with HF between 1993 and 2006. Researchers measured length of hospital stay, all-cause 30-day readmission, and all-cause 30-day mortality. They also evaluated in-hospital mortality and postdischarge mortality.
 
Mean length of hospital stay decreased from 8.81 days in 1993 to 6.33 days in 2006. In-hospital mortality declined from 8.5% in 1993 to 4.3% in 2006, while 30-day mortality declined from 12.8% to 10.7% during the same time period.
 
Despite those reductions, 30-day readmission rates increased from 17.2% to 20.1% during the study period.
 
Discharges to home or under home care service decreased from 74% to 66.9%, whereas discharges to skilled nursing facilities increased from 13% to 19.9%.
 
Similar to the unadjusted analyses, during 2005-2006, the risk-adjusted 30-day mortality risk ratio was 0.92 (95% CI, 0.91-0.93) and the 30-day readmission risk ratio was 1.11 (95% CI, 1.10-1.11) compared with 1993-1994.
 
"The current model of care for older patients with HF in the United States may benefit from more attention to the care and outcomes in the early transition period after hospital discharge and routine surveillance of how changes in practice affect patient outcomes," the investigators concluded. (Bueno H, et al. JAMA 2010;303:2141-2147.)

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