title: Heart failure readmission after mitral valve repair and replacement: five-year follow-up in the Medicare population.
abstract: BACKGROUND
  Readmission rates are well established as a quality indicator for heart failure (HF). We analyzed HF readmission rates after mitral valve repair (MVP) and replacement (MVR).
  
  
  METHODS
  We included 21,138 Medicare beneficiaries with primary isolated MVP (n=6,896) or MVR (n=14,242) from 2000 through 2004. Readmission rates were identified using MedPar records subsequent to the index procedure during a 5-year follow-up. Treating death as a competing risk, cumulative readmission incidences were analyzed and stratified by presence or absence of preoperative HF.
  
  
  RESULTS
  Preoperative HF was present in 61.0% of the patients. All-cause readmission rates were 24.9% at 30 days and 78.0% at 5 years. The cumulative incidence of readmission for HF remained almost 3 times higher in patients with preoperative HF compared with those without for MVP (2.1% vs 5.9% in 30 days and 10.3% vs 26.3% in 5 years) and 2 times higher for MVR (3.6% vs 7.4% in 30 days and 15.8% vs 30.4% in 5 years). Regardless of procedure type, patients without preoperative HF had significantly lower HF readmission rates (3.0% vs 7.0% in the first 30 days and 13.6% vs 29.2% after 5 years) (p=0.0001).
  
  
  CONCLUSIONS
  Hospital readmission after mitral surgery is high. Preoperative heart failure is associated with higher postoperative readmission rates. Because admission for heart failure accounts for a significant proportion of these readmissions, close follow-up of patients with known mitral valve disease and referral to surgery prior to development of heart failure may decrease postoperative readmission rates.
authors.affiliation: Southern Illinois University School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Springfield, Illinois. Electronic address: cvassileva@siumed.edu.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Vassileva
authors.affiliation: Southern Illinois University School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Springfield, Illinois.
authors.forename: Naseem
authors.initials: N
authors.lastname: Ghazanfari
authors.affiliation: Saint Luke's Mid America Heart Institute/University of Missouri, Kansas City, Kansas City, Missouri.
authors.forename: John
authors.initials: J
authors.lastname: Spertus
authors.affiliation: Southern Illinois University School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Springfield, Illinois.
authors.forename: Christian
authors.initials: C
authors.lastname: McNeely
authors.affiliation: Southern Illinois University School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Springfield, Illinois.
authors.forename: Stephen
authors.initials: S
authors.lastname: Markwell
authors.affiliation: Southern Illinois University School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Springfield, Illinois.
authors.forename: Stephen
authors.initials: S
authors.lastname: Hazelrigg
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare; D008946:Mitral Valve Stenosis / Q000601:surgery*; D010359:Patient Readmission / Q000639:trends*; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology