HHS Public Access Author manuscript Author Manuscript
Am J Med. Author manuscript; available in PMC 2017 November 01. Published in final edited form as: Am J Med. 2016 November ; 129(11): 1178–1184. doi:10.1016/j.amjmed.2016.06.018.
Association of 30-day All-cause Readmission with Long-term Outcomes in Hospitalized Older Medicare Beneficiaries with Heart Failure
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Cherinne Arundel, MD#1, Phillip H. Lam, MD#2, Rahul Khosla, MD1, Marc R. Blackman, MD1, Gregg C. Fonarow, MD3, Charity Morgan, PhD4, Qing Zeng, PhD5, Ross D. Fletcher, MD1, Javed Butler, MD6, Wen-Chih Wu, MD7, Prakash Deedwania, MD8, Thomas E. Love, PhD9, Michel White, MD10, Wilbert S. Aronow, MD11, Stefan D. Anker, MD, PhD12, Richard M. Allman, MD13, and Ali Ahmed, MD, MPH1,4,* 1Veterans
Affairs Medical Center, Washington, DC
2Georgetown
University Hospital/Washington Hospital Center, Washington, DC
3University
of California, Los Angeles, CA
4University
of Alabama at Birmingham, Birmingham, AL
5George 6State
Washington University, Washington, DC
University of New York, Stony Brook, NY
7Veterans
Affairs Medical Center, Providence, RI
Author Manuscript
8University 9Case
Western Reserve University, Cleveland, OH
10Montreal 11New
of California San Francisco, CA
Heart Institute, Montreal, Canada
York Medical College, Valhalla, NY
12University
of Göttingen, Göttingen, Germany
13Department
#
of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC
These authors contributed equally to this work.
Abstract Author Manuscript
BACKGROUND—Heart failure is the leading cause for 30-day all-cause readmission. We examined the impact of 30-day all-cause readmission on long-term outcomes and cost in a propensity score matched study of hospitalized patients with heart failure.
*
Correspondence: Ali Ahmed, MD, MPH, Center for Health and Aging, Washington DC VA Medical Center, 50 Irving St. NW, Washington, DC 20422; Telephone: 1-202-745-8386;
[email protected]. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Conflict of interest: None of the authors reported conflicts of interest related to this work.
Arundel et al.
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METHODS—Of the 7578 Medicare beneficiaries discharged with a primary diagnosis of heart failure from 106 Alabama hospitals (1998–2001) and alive at 30-day post-discharge, 1519 had 30day all-cause readmissions. Using propensity scores for 30-day all-cause readmission, we assembled a matched cohort of 1516 pairs of patients with and without 30-day all-cause readmissions, balanced on 34 baseline characteristics (mean age 75 years, 56% women, 24% African American).
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RESULTS—During 2-12 months of follow-up after discharge from index hospitalization, allcause mortality occurred in 41% and 27% of matched patients with and without 30-day all-cause readmission, respectively (hazard ratio {HR}, 1.68; 95% confidence interval {CI}, 1.48–1.90; p