title: Hospital Readmission after Aortic Valve Replacement: Impact of Preoperative Heart Failure.
abstract: Large-scale data of heart failure (HF) readmission after aortic valve replacement (AVR) are limited.
  
  
  
  A total of 40,751 Medicare beneficiaries >65 years who underwent primary isolated AVR between 2000 and 2004 were included in the study. Preoperative HF was defined using ICD-9-CM diagnostic codes from the index admission and any hospitalization during the preceding year. Cumulative readmission incidences over five years were computed for those patients with and without preoperative HF, while adjusting for propensity scores.
  
  
  
  The median patient age was 76 years. At 30 days, all-cause readmission was 21.5% and HF readmission was 3.9%. Patients with preoperative HF had higher postoperative HF readmission rates compared to those without (30 days, 6.3% versus 2.2%; one year, 13.9% versus 4.4%; five years, 6.6% versus 10.3%, p = 0.0001). The incremental risk of HF on readmission was >2 following adjustment. In patients with preoperative HF, the number of admissions was associated with increased postoperative HF readmissions. At 30 days, patients with no preoperative HF admissions had a HF readmission rate of 5.3%, while those with one, two, three and four or more preoperative HF admissions had rates of 8.2%, 11.9%, 13.8% and 17.4%, respectively. This trend persisted over the five-year follow up period.
  
  
  
  Postoperative HF readmission accounted for about one-fifth of all-cause readmissions after AVR in Medicare beneficiaries. Preoperative HF significantly contributed to postoperative readmission, both all-cause and HF-specific, which likely limits the symptomatic benefit of surgery. These data support early aortic valve intervention prior to the development of clinically apparent HF.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA.|Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: McNeely
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA.|Division of Cardiovascular Medicine, Wayne State University, Detroit, MI, USA.
authors.forename: Tesfaye
authors.initials: T
authors.lastname: Telila
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Markwell
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Hazelrigg
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA. Electronic correspondence: Vassileva@musc.edu.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Vassileva
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000175:diagnosis*; D012307:Risk Factors; D014481:United States