Readmissions and the quality of care in patients hospitalized with heart failure.
OBJECTIVE
Clinical practice guidelines based on the results of randomized clinical trials recommend that patients with heart failure due to left ventricular systolic dysfunction (LVSD) be treated with angiotensin-converting enzyme inhibitors (ACEI) at doses shown to reduce mortality and readmission. This study examined the relationship between ACEI use at discharge and readmission among patients with heart failure due to LVSD.


RESULTS
Data were abstracted from the medical records of 2943 randomly selected patients hospitalized for heart failure in 50 hospitals. The outcome of interest was the number of readmissions occurring up to 21 months after discharge. Six-hundred and eleven patients were eligible for analysis. Compared with patients discharged at a recommended ACEI dose, patients not prescribed an ACEI at discharge had an adjusted rate ratio of readmission (RR) of 1.74 [95% confidence interval (CI) 1.22-2.48], while patients prescribed an ACEI at less than a recommended dose had an RR of 1.24 (95% CI 0.91-1.69) (P = 0.005 for the trend).


CONCLUSIONS
Our results show that ACEI use at discharge in patients with LVSD is associated with decreased rate of readmission. These findings suggest that compliance with the ACEI prescribing recommendations listed in clinical practice guidelines for patients with heart failure due to LVSD confers benefit.
Luthi
Jean-Christophe
JC
Institute of Social and Preventive Medicine, University of Lausanne, Switzerland. Jean-Christophe.Luthi@inst.hospvd.ch
Lund
Mary Jo
MJ
Sampietro-Colom
Laura
L
Kleinbaum
David G
DG
Ballard
David J
DJ
McClellan
William M
WM
D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012907:Smoking; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000188:drug therapy*
D000806:Angiotensin-Converting Enzyme Inhibitors