Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993-2006.
BACKGROUND
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.


METHODS
An observational study of 6,955,461 Medicare fee-for-service hospitalizations for HF between 1993 and 2006, with a 30-day follow-up.


METHODS
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).


CONCLUSIONS
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.
Bueno
Héctor
H
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Ross
Joseph S
JS
Wang
Yun
Y
Chen
Jersey
J
Vidán
María T
MT
Normand
Sharon-Lise T
SL
Curtis
Jeptha P
JP
Drye
Elizabeth E
EE
Lichtman
Judith H
JH
Keenan
Patricia S
PS
Kosiborod
Mikhail
M
Krumholz
Harlan M
HM
D000368:Aged; D000369:Aged, 80 and over; D018588:Fee-for-Service Plans; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States