title: Association of 30-Day All-Cause Readmission with Long-Term Outcomes in Hospitalized Older Medicare Beneficiaries with Heart Failure.
abstract: BACKGROUND
  Heart failure is the leading cause for 30-day all-cause readmission. We examined the impact of 30-day all-cause readmission on long-term outcomes and cost in a propensity score-matched study of hospitalized patients with heart failure.
  
  
  METHODS
  Of the 7578 Medicare beneficiaries discharged with a primary diagnosis of heart failure from 106 Alabama hospitals (1998-2001) and alive at 30 days after discharge, 1519 had a 30-day all-cause readmission. Using propensity scores for 30-day all-cause readmission, we assembled a matched cohort of 1516 pairs of patients with and without a 30-day all-cause readmission, balanced on 34 baseline characteristics (mean age 75 years, 56% women, 24% African American).
  
  
  RESULTS
  During 2-12 months of follow-up after discharge from index hospitalization, all-cause mortality occurred in 41% and 27% of matched patients with and without a 30-day all-cause readmission, respectively (hazard ratio 1.68; 95% confidence interval 1.48-1.90; P <.001). This harmful association of 30-day all-cause readmission with mortality persisted during an average follow-up of 3.1 (maximum, 8.7) years (hazard ratio 1.33; 95% confidence interval 1.22-1.45; P <.001). Patients with a 30-day all-cause readmission had higher cumulative all-cause readmission (mean, 6.9 vs 5.1; P <.001), a longer cumulative length of stay (mean, 51 vs 43 days; P <.001), and a higher cumulative cost (mean, $38,972 vs $34,025; P = .001) during 8.7 years of follow-up.
  
  
  CONCLUSIONS
  Among Medicare beneficiaries hospitalized for heart failure, 30-day all-cause readmission was associated with a higher risk of subsequent all-cause mortality, higher number of cumulative all-cause readmission, longer cumulative length of stay, and higher cumulative cost.
authors.affiliation: Veterans Affairs Medical Center, Washington, DC.
authors.forename: Cherinne
authors.initials: C
authors.lastname: Arundel
authors.affiliation: Georgetown University Hospital/Washington Hospital Center, Washington, DC.
authors.forename: Phillip H
authors.initials: PH
authors.lastname: Lam
authors.affiliation: Veterans Affairs Medical Center, Washington, DC.
authors.forename: Rahul
authors.initials: R
authors.lastname: Khosla
authors.affiliation: Veterans Affairs Medical Center, Washington, DC.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Blackman
authors.affiliation: University of California, Los Angeles, CA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Charity
authors.initials: C
authors.lastname: Morgan
authors.affiliation: George Washington University, Washington, DC.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zeng
authors.affiliation: Veterans Affairs Medical Center, Washington, DC.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Fletcher
authors.affiliation: State University of New York, Stony Brook, NY.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: Veterans Affairs Medical Center, Providence, RI.
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Wu
authors.affiliation: University of California San Francisco, CA.
authors.forename: Prakash
authors.initials: P
authors.lastname: Deedwania
authors.affiliation: Case Western Reserve University, Cleveland, OH.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Love
authors.affiliation: Montreal Heart Institute, Montreal, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: White
authors.affiliation: New York Medical College, Valhalla, NY.
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.affiliation: University of Göttingen, Göttingen, Germany.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
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.|University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000407:Alabama / Q000453:epidemiology; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States
keywords: 30-Day all-cause readmission; All-cause mortality; Cost; Heart failure; Medicare beneficiaries