title: Beta-blocker Use and 30-day All-cause Readmission in Medicare Beneficiaries with Systolic Heart Failure.
abstract: BACKGROUND
  Beta-blockers improve outcomes in patients with systolic heart failure. However, it is unknown whether their initial negative inotropic effect may increase 30-day all-cause readmission, a target outcome for Medicare cost reduction and financial penalty for hospitals under the Affordable Care Act.
  
  
  METHODS
  Of the 3067 Medicare beneficiaries discharged alive from 106 Alabama hospitals (1998-2001) with a primary discharge diagnosis of heart failure and ejection fraction <45%, 2202 were not previously on beta-blocker therapy, of which 383 received new discharge prescriptions for beta-blockers. Propensity scores for beta-blocker use, estimated for each of the 2202 patients, were used to assemble a matched cohort of 380 pairs of patients receiving and not receiving beta-blockers who were balanced on 36 baseline characteristics (mean age 73 years, mean ejection fraction 27%, 45% women, 33% African American).
  
  
  RESULTS
  Beta-blocker use was not associated with 30-day all-cause readmission (hazard ratio [HR] 0.87; 95% confidence interval [CI], 0.64-1.18) or heart failure readmission (HR 0.95; 95% CI, 0.57-1.58), but was significantly associated with lower 30-day all-cause mortality (HR 0.29; 95% CI, 0.12-0.73). During 4-year postdischarge, those in the beta-blocker group had lower mortality (HR 0.81; 95% CI, 0.67-0.98) and combined outcome of all-cause mortality or all-cause readmission (HR 0.87; 95% CI, 0.74-0.97), but not with all-cause readmission (HR 0.89; 95% CI, 0.76-1.04).
  
  
  CONCLUSIONS
  Among hospitalized older patients with systolic heart failure, discharge prescription of beta-blockers was associated with lower 30-day all-cause mortality and 4-year combined death or readmission outcomes without higher 30-day readmission.
authors.affiliation: University of Alabama at Birmingham, Birmingham, Ala; Veterans Affairs Medical Center, Birmingham, Ala. Electronic address: vikasbhatiamamc@gmail.com.
authors.forename: Vikas
authors.initials: V
authors.lastname: Bhatia
authors.affiliation: University of Alabama at Birmingham, Birmingham, Ala; Veterans Affairs Medical Center, Birmingham, Ala.
authors.forename: Navkaranbir S
authors.initials: NS
authors.lastname: Bajaj
authors.affiliation: University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: Kumar
authors.initials: K
authors.lastname: Sanam
authors.affiliation: University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: Taimoor
authors.initials: T
authors.lastname: Hashim
authors.affiliation: University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: Charity J
authors.initials: CJ
authors.lastname: Morgan
authors.affiliation: University of Alabama at Birmingham, Birmingham, Ala; Veterans Affairs Medical Center, Birmingham, Ala.
authors.forename: Sumanth D
authors.initials: SD
authors.lastname: Prabhu
authors.affiliation: University of California, Los Angeles.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: University of California, San Francisco, Fresno.
authors.forename: Prakash
authors.initials: P
authors.lastname: Deedwania
authors.affiliation: Stony Brook University, Stony Brook, NY.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: Veterans Affairs Medical Center, Washington, DC.
authors.forename: Peter
authors.initials: P
authors.lastname: Carson
authors.affiliation: Case Western Reserve University, Cleveland, Ohio.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Love
authors.affiliation: Veterans Affairs Medical Center, Washington, DC.
authors.forename: Raya
authors.initials: R
authors.lastname: Kheirbek
authors.affiliation: New York Medical College, Valhalla.
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.affiliation: Department of Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.affiliation: University of Gothenburg, Gothenburg, Sweden.
authors.forename: Finn
authors.initials: F
authors.lastname: Waagstein
authors.affiliation: Veterans Affairs Medical Center, Washington, DC.
authors.forename: Ross
authors.initials: R
authors.lastname: Fletcher
authors.affiliation: Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Allman
authors.affiliation: Veterans Affairs Medical Center, Washington, DC.
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D006278:Medicare; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act / Q000191:economics; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Beta-blockers; Hospitalization; Older adults; Readmission; Systolic heart failure