title: Divergent trends in survival and readmission following a hospitalization for heart failure in the Veterans Affairs health care system 2002 to 2006.
abstract: OBJECTIVE
  This study sought to determine recent trends over time in heart failure hospitalization, patient characteristics, treatment, rehospitalization, and mortality within the Veterans Affairs health care system.
  
  
  BACKGROUND
  Use of recommended therapies for heart failure has increased in the U.S. However, it is unclear to what extent hospitalization rates and the associated mortality have improved.
  
  
  METHODS
  We compared rates of hospitalization for heart failure, 30-day rehospitalization for heart failure, and 30-day mortality following discharge from 2002 to 2006 in the Veterans Affairs Health Care System. Odds ratios for outcome were adjusted for patient diagnoses within the past year, laboratory data, and for clustering of patients within hospitals.
  
  
  RESULTS
  We identified 50,125 patients with a first hospitalization for heart failure from 2002 to 2006. Mean age did not change (70 years), but increases were noted for most comorbidities (mean Charlson score increased from 1.72 to 1.89, p < 0.0001). Heart failure admission rates remained constant at about 5 per 1,000 veterans. Mortality at 30 days decreased (7.1% to 5.0%, p < 0.0001), whereas rehospitalization for heart failure at 30 days increased (5.6% to 6.1%, p = 0.11). After adjustment for patient characteristics, the odds ratio for rehospitalization in 2006 (vs. 2002) was 0.54 (95% confidence interval [CI]: 0.47 to 0.61) for mortality, but 1.21 (95% CI: 1.04 to 1.41) for heart failure rehospitalization at 30 days.
  
  
  CONCLUSIONS
  Recent mortality and rehospitalization rates in the Veterans Affairs Health Care System have trended in opposite directions. These results have implications for using rehospitalization as a measure of quality of care.
authors.affiliation: VA Palo Alto Health Care System, Palo Alto, California 94304, USA. heiden@stanford.edu
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.forename: Anju
authors.initials: A
authors.lastname: Sahay
authors.forename: John R
authors.initials: JR
authors.lastname: Kapoor
authors.forename: Michael X
authors.initials: MX
authors.lastname: Pham
authors.forename: Barry
authors.initials: B
authors.lastname: Massie
mesh_terms: D000368:Aged; D016000:Cluster Analysis; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs