Divergent Trends in Survival and Readmission Following a Hospitalization for Heart Failure in the Veterans Affairs Health Care System 2002 to 2006

Objectives. This study sought to determine recent trends over time in heart failure (HF) hospitalization, patient characteristics, treatment, rehospitalization, and mortality within the Veterans Affairs health care system. Background. Use of recommended therapies for HF has increased in the United States; however, it is unclear to what extent hospitalization rates and the associated mortality have improved. Methods. We compared rates of hospitalization for HF, 30-day rehospitalization for HF, and 30-day mortality following discharge from 2002–2006 in the Veterans Affairs health care system. Odds ratios for outcome were adjusted for patient diagnoses within the past year, laboratory data, and clustering of patients within hospitals. Results. We identified 50,125 patients with a first hospitalization for HF from 2002–2006. Mean age did not change (70 years), but increases were noted for most comorbidities (mean Charlson score increased from 1.72 to 1.89; P<.0001). HF admission rates remained constant at about 5 per 1000 veterans. Mortality at 30 days decreased (7.1%–5.0%; P<.0001), whereas rehospitalization for HF at 30 days increased (5.6%–6.1%; P=.11). After adjustment for patient characteristics, the odds ratio for rehospitalization in 2006 (vs 2002) was 0.54 (95% confidence interval [CI], 0.47–0.61) for mortality, but 1.21 (95% CI, 1.04–1.41) for HF rehospitalization at 30 days. Conclusions. Recent mortality and rehospitalization rates in the Veterans Affairs health care system have trended in opposite directions. These results have implications for using rehospitalization as a measure of quality of care.—Heidenreich PA, Sahay A, Kapoor JR, et al. Divergent trends in survival and readmission following a hospitalization for heart failure in the Veterans Affairs health care system 2002 to 2006. J Am Coll Cardiol. 2010;56:362–368.