Trends in Length of Stay and Short-term Outcomes Among Medicare Patients Hospitalized for Heart Failure, 1993-2006
- Héctor Bueno, MD, PhD;
- Joseph S. Ross, MD, MHS;
- Yun Wang, PhD;
- Jersey Chen, MD, MPH;
- María T. Vidán, MD, PhD;
- Sharon-Lise T. Normand, PhD;
- Jeptha P. Curtis, MD;
- Elizabeth E. Drye, MD, SM;
- Judith H. Lichtman, PhD;
- Patricia S. Keenan, PhD;
- Mikhail Kosiborod, MD;
- Harlan M. Krumholz, MD, SM
- Author Affiliations: Department of Cardiology (Dr Bueno) and Service of Geriatric Medicine (Dr Vidán), Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, and HSR&D Research Enhancement Award Program and Geriatrics Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx (Dr Ross), New York; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut (Drs Wang, Chen, Curtis, Drye, and Krumholz); Department of Internal Medicine (Drs Wang, Chen, Curtis, Drye, and Krumholz), Robert Wood Johnson Clinical Scholars Program (Dr Krumholz), and Sections of Chronic Disease Epidemiology (Dr Lichtman) and Health Policy and Administration (Drs Keenan and Krumholz), School of Public Health, Yale University School of Medicine, New Haven, Connecticut; Department of Health Care Policy, Harvard Medical School, and Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts (Dr Normand); and Mid America Heart Institute of St Luke's Hospital and Department of Medicine, University of Missouri, Kansas City (Dr Kosiborod).
Abstract
Context Whether decreases in the length of stay during the past decade for patients with heart failure (HF) may be associated with changes in outcomes is unknown.
Objective To describe the temporal changes in length of stay, discharge disposition, and short-term outcomes among older patients hospitalized for HF.
Design, Setting, and Participants An observational study of 6 955 461 Medicare fee-for-service hospitalizations for HF between 1993 and 2006, with a 30-day follow-up.
Main Outcome Measures Length of hospital stay, in-patient and 30-day mortality, and 30-day readmission rates.
Results Between 1993 and 2006, mean length of stay decreased from 8.81 days (95% confidence interval [CI], 8.79-8.83 days) to 6.33 days (95% CI, 6.32-6.34 days). In-hospital mortality decreased from 8.5% (95% CI, 8.4%-8.6%) in 1993 to 4.3% (95% CI, 4.2%-4.4%) in 2006, whereas 30-day mortality decreased from 12.8% (95% CI, 12.8%-12.9%) to 10.7% (95% CI, 10.7%-10.8%). Discharges to home or under home care service decreased from 74.0% to 66.9% and discharges to skilled nursing facilities increased from 13.0% to 19.9%. Thirty-day readmission rates increased from 17.2% (95% CI, 17.1%-17.3%) to 20.1% (95% CI, 20.0%-20.2%; all P < .001). Consistent with the unadjusted analyses, the 2005-2006 risk-adjusted 30-day mortality risk ratio was 0.92 (95% CI, 0.91-0.93) compared with 1993-1994, and the 30-day readmission risk ratio was 1.11 (95% CI, 1.10-1.11).
Conclusion For patients admitted with HF during the past 14 years, reductions in length of stay and in-hospital mortality, less marked reductions in 30-day mortality, and changes in discharge disposition accompanied by increases in 30-day readmission rates were observed.
