Association Between the Hospital Readmissions Reduction Program and Heart Failure Subtype Readmissions and Mortality in the USA

Background: The Hospital Readmission Reduction Program (HRRP) sought to reduce readmissions by penalising centres with readmissions above the national average, and heart failure (HF) is the leading driver of the readmission penalty. Recent Medicare analyses question the effectiveness of this strategy. This study evaluated the efficacy of HRRP by utilising large national datasets and is the first to analyse based on heart failure subtypes. Methods: Aggregate data was used from the National Inpatient Sample (NIS) to study mortality and the National Readmissions Database (NRD) to study readmissions. Both included all payer-types and were stratified by heart failure subtype and time (pre- and post-HRRP implementation). Results: Patients with HF with preserved ejection fraction (HFpEF) tended to be older females with a higher proportion of comorbidities compared to patients with HF with reduced ejection fraction (HFrEF). In the post-HRRP period, readmission rates decreased for HFrEF (21.4% versus 22.3%, p<0.001) and HFpEF (21.2% versus 22.4%, p<0.001); readmission rates for the two subtypes were not statistically different compared to the other. Post-HRRP, inpatient mortality was consistent for HFrEF (2.8% versus 2.8%, p=0.087), but decreased for HFpEF (2.4% versus 2.5%, p=0.029). There were no significant differences noted in average length of stay. Patients with HFrEF were more frequently discharged to short-term hospitals or home with home healthcare, and patients with HFpEF were discharged to skilled nursing facilities more often. Estimated inpatient costs decreased in both subtypes post-HRRP, but readmission costs were higher for HFrEF. Conclusions: This study suggests that HRRP was associated with minimal change in readmission and inpatient mortality.