title: Mortality and readmission rates in patients hospitalized for acute decompensated heart failure: a comparison between cardiology and general-medicine service outcomes in an underserved population.
abstract: BACKGROUND
  With recent legislation imposing penalties on hospitals for above-average 30-day all-cause readmissions for patients with acute decompensated heart failure (ADHF), there is concern these penalties will more heavily impact hospitals serving socioeconomically vulnerable and underserved populations.
  
  
  OBJECTIVE
  Patients with ADHF and low socioeconomic status have better postdischarge mortality and readmission outcomes when cardiologists are involved in their in-hospital care.
  
  
  METHODS
  We retrospectively searched the electronic medical record for patients hospitalized for ADHF from 2001 to 2010 in 3 urban hospitals within a large university-based health system. These patients were divided into 2 groups based on whether a cardiologist was involved in their care or not. Measured outcomes were 30- and 60-day postdischarge mortality and readmission rates.
  
  
  RESULTS
  Out of the 7516 ADHF patients, 1434 patients were seen by a cardiologist (19%). These patients had lower 60-day mortality (5.4% vs 7.0%; hazard ratio [HR]: 0.70, 95% confidence interval [CI]: 0.52-0.96, P = 0.034) and lower 30- and 60-day readmission rates (16.7% vs 20.6%; HR: 0.76, 95% CI: 0.66-0.89, P = 0.002, and 26.1% vs 30.2%; HR: 0.81, 95% CI: 0.72-0.92, P = 0.003, respectively). There was no significant difference in the in-hospital mortality between the 2 groups. Compared with other races, whites with systolic HF have marginally lower HF-related readmission rates when treated by cardiologists.
  
  
  CONCLUSIONS
  In this cohort of ADHF patients from the Bronx, New York, involvement of a cardiologist resulted in improved short-term mortality and readmission outcomes compared with treatment by general internal medicine.
authors.affiliation: Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Selim
authors.forename: Jeremy A
authors.initials: JA
authors.lastname: Mazurek
authors.forename: Muhammad
authors.initials: M
authors.lastname: Iqbal
authors.forename: Dan
authors.initials: D
authors.lastname: Wang
authors.forename: Abdissa
authors.initials: A
authors.lastname: Negassa
authors.forename: Ronald
authors.initials: R
authors.lastname: Zolty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016507:Cardiology Service, Hospital; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality* / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D008913:Minority Groups; D009519:New York City / Q000453:epidemiology; D010359:Patient Readmission; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013038:Specialization; D013997:Time Factors; D016896:Treatment Outcome; D014504:Urban Health; D035862:Vulnerable Populations