Clinical InvestigationsA Hospital Level Analysis of 30-Day Readmission Performance for Heart Failure Patients and Long-Term Survival: Findings from Get With The Guidelines-Heart Failure
Section snippets
Data source
The GWTG-HF database linked with CMS claims were the primary sources of the data. The design and objectives of the GWTG-HF registry have previously been described.11., 12., 13., 14. In brief, this registry includes more than 300 participating hospitals from each geographical region of the US. The registry includes teaching, non-teaching and community hospitals from both rural and urban areas, making it a comprehensive representation of the diversified US population of patients hospitalized with
Results
This study included 37,457 patients hospitalized with HF from 132 hospitals participating in GWTG-HF. The overall 30-day readmission rate was 19.8%. The quartiles for hospital performance on the 30-day RSRR measures were as follows: 11,181 patients were from hospitals which were in top 25% in their 30-day RSRR 14.9%-18.3%; 10,367 patients from 2nd quartile (25-50%) 30-day RSRR 18.3%-19.9%; 8729 patients in 3rd quartile (50-75%), 30-day RSSR 19.9%-21.3%; and 7189 patients in the bottom
Discussion
In this study of patients hospitalized with HF, we found no significant differences in risk-adjusted 3-year and median survival of HF patients admitted at the hospitals performing highest and lowest on 30-day RSRR. In unadjusted analyses, hospitals with the worst performance on the 30-day RSRR measure actually had HF patients with better median-survival duration and the lowest observed 3-year mortality when compared to the hospitals with best performance on the 30-day RSRR measure. There were
Conclusions
Hospital performance based on the CMS metric of 30-day RSRR in patients hospitalized for HF had no or little correlation with long-term survival of these patients. These finding raise concerns regarding additional limitations of the CMS HRRP and potential unintended consequences for Medicare beneficiaries. There is an important need to identify and utilize more meaningful and patient-centered outcome measures for reporting and incentivizing quality care for HF.
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Early Unplanned Readmissions After Admission to Hospital With Heart Failure
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Javed Butler, MD, MPH served as guest editor for this article.
Funding Sources: The American Heart Association provides the Get With The Guidelines Heart Failure program (GWTG-HF). GWTG-HF has been previously funded through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the AHA Pharmaceutical Roundtable.
Author Disclosures: Dr. Deepak L. Bhatt discloses the following relationships - Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott); Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, PLx Pharma, Takeda. Dr. Adam D. DeVore reports research support from the American Heart Association, Amgen, and Novartis and consulting with Novartis. Dr Gregg Fonarow reports research support from NIH, consulting with Abbott, Amgen, Novartis, and Medtronic, and serving as a GWTG Steering Committee member. All other authors have nothing to disclose.