title: Does the United States economy affect heart failure readmissions? A single metropolitan center analysis.
abstract: BACKGROUND
  To determine the effects of the US economy on heart failure hospitalization rates.
  
  
  OBJECTIVE
  The recession was associated with worsening unemployment, loss of private insurance and prescription medication benefits, medication nonadherence, and ultimately increased rates of hospitalization for heart failure.
  
  
  METHODS
  We compared hospitalization rates at a large, single, academic medical center from July 1, 2006 to February 28, 2007, a time of economic stability, and July 1, 2008 to February 28, 2009, a time of economic recession in the United States.
  
  
  RESULTS
  Significantly fewer patients had private medical insurance during the economic recession than during the control period (36.5% vs 46%; P = 0.04). Despite this, there were no differences in the heart failure hospitalization or readmission rates, length of hospitalization, need for admission to an intensive care unit, in-hospital mortality, or use of guideline-recommended heart failure medications between the 2 study periods.
  
  
  CONCLUSIONS
  We conclude that despite significant effects on medical insurance coverage, rates of heart failure hospitalization at our institution were not significantly affected by the recession. Additional large-scale population-based research is needed to better understand the effects of fluctuations in the US economy on heart failure hospitalization rates.
authors.affiliation: Department of Medicine, Division of Cardiology, Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, California 90048, USA.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Thompson
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Morrissey
authors.forename: Anita
authors.initials: A
authors.lastname: Phan
authors.forename: Ernst R
authors.initials: ER
authors.lastname: Schwarz
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000223:Adaptation, Psychological; D057172:Economic Recession / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000191:economics* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D007902:Length of Stay; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D013315:Stress, Psychological / Q000150:complications*; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology