Circulation: Heart Failure Editors’ Picks

Medicare's introduction of public reporting and value-based purchasing centered on 30-day risk-adjusted readmission rates after hospital discharge for heart failure (HF) has helped to heighten interest among state governments and commercial payers in HF readmissions.As all potentially avoidable HF readmissions represent an opportunity to improve healthcare quality and efficiency, understanding the rates and predictors in non-Medicare populations is important.This is particularly true among patients with systolic dysfunction, for whom most HF-specific therapies are targeted.Using claims-based administrative data, we evaluated 1198 Medicaid and 3350 commercially insured unique systolic HF index admissions.All patients were <65 years of age, with a mean age of 55 years.Unadjusted all-cause 30-day readmission rates were 17.4% for Medicaid enrollees and 11.8% for commercially insured patients.After adjustment for differences in case mix, the odds of all-cause readmission were 32% higher among Medicaid than commercially insured patients, and 68% higher when only HF-related readmissions were considered.No significant differences in readmission rates were seen for managed care versus fee-for-service or capitated versus noncapitated plan types.These results suggest that socioeconomically disadvantaged populations, as indicated by Medicaid insurer status, represent a high-risk population potentially warranting specific interventions.Conclusions: Compared with commonly cited Medicare HF readmission rates of 20% to 25%, Medicaid patients with systolic HF had lower 30-day readmission rates, and commercially insured patients had even lower rates.Even after adjustment for case mix, Medicaid patients were more likely to be readmitted than commercially insured patients, suggesting that more attention should be focused on readmissions among socioeconomically disadvantaged populations. 1 Lifetime Analysis of Hospitalizations and Survival of Patients Newly Admitted With Heart FailureSummary: Hospital readmissions for heart failure (HF) contribute to increased morbidity and resource burden.However, the predictors of hospitalization and patterns of cardiovascular events during the lifetime of patients with HF have not been elucidated.In this study, the authors examined recurrent hospitalizations, cardiovascular events, and survival over extended follow-up among patients with HF who were newly discharged.Among 8543 patients followed for 22 567 personyears, 60.7% had HF of ischemic etiology and HF with reduced ejection fraction (left ventricular ejection fraction ≤45% versus >45% [HF with preserved ejection fraction]) was present in 67.3%.During the 10-year follow-up period, 98.8% of the cohort died, and 35 966 hospital readmissions occurred.Cardiovascular readmissions occurred frequently and were largely due to episodes of recurrent HF.Within the first year postdischarge, 66.5% of patients were rehospitalized for cardiovascular disease, and 61.3% were readmitted for HF.There was a preponderance of readmissions in the months comprising the initial and final deciles of the lifespan of the cohort.Of all recurrent HF hospitalizations, 26.8% occurred in the first and 39.8% in the last deciles of cohort survival duration.Similarly, 29.7% and 52.3% of all cardiovascular readmissions occurred in the first and last deciles of the cohort survival duration, respectively.The presence of ischemic HF etiology was a ubiquitous predictor of the first cardiovascular readmission, recurrent hospitalizations for cardiovascular, HF, and coronary heart disease on repeatedevents analysis.Although presence of HF with reduced ejection fraction was associated with a shorter time to first recurrent HF or coronary heart disease readmission, it was not a predictor of repeat hospitalizations.Conclusions: Among newly discharged patients with HF, cardiovascular events were clustered at early postdischarge and prefatal time periods, and were increased among those with ischemic etiology.2