Published: June 1, 2010
New Haven, Conn. - While the rate of in-hospital and 30-day mortality has decreased, the number of heart failure patients being readmitted to the hospital or discharged to a skilled nursing facility has increased, Yale School of Medicine researchers report in the June 2 issue of the Journal of the American Medical Association (JAMA).
"As clinicians, we tend to focus our attention on heart failure patients at the point of admission to the hospital and during their stay, but when they are stable and ready for discharge, we need to ensure that they are able to maintain their health outside of the hospital," said lead author of the study Harlan M. Krumholz, M.D., the Harold H. Hines, Jr. Professor of Medicine and Epidemiology and Public Health at Yale.
Krumholz said it could be as simple as ensuring that patients have a way to pick up their medication and are taking the medication as instructed.
Krumholz and his co-authors conducted an analysis of Medicare data from 1993 through 2006 of older patients hospitalized for heart failure. They found that during that time, the average length of stay decreased from 8.8 days to 6.3 days. They also found that in-hospital mortality decreased from 8.5 percent in 1993 to 4.3 percent in 2006, a 49 percent relative reduction; and the 30-day mortality rate decreased by 2.1 percent. During this period, 30-day hospital readmission rates increased from 17.2 percent to 20.1 percent, and discharge to skilled nursing facilities increased from 13 percent to 19.9 percent.
Krumholz said the current model of care for older heart failure patients might benefit from more attention to the care and outcomes in the early period after hospital discharge, and routine surveillance of how changes in practice affect patient outcomes.
Other authors on the study included first author Hector Bueno, M.D., Joseph S. Ross, M.D., Yun Wang, Jersey Chen, M.D., Maria T. Vidan, M.D., Sharon-Lise T. Normand, Jeptha P. Curtis, M.D., Elizabeth E. Drye, M.D., Judith H. Lichtman, Patricia S. Keenan and Mikhail Kosiborod, M.D.
Citation: JAMA Vol. 303, No. 21, Pages 2141-2147 (June 2, 2010)
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