Readmission and Mortality After Hospitalization for Myocardial Infarction and Heart Failure
Key result
Ontario AMI and HF hospitalizations show declines in 30-day readmissions and post-discharge mortality.
- n=376,091
Why the study?
Readmission rates after AMI and HF hospitalizations decreased in the United States following the Hospital Readmissions Reduction Program, prompting examination of temporal trends in readmission and mortality in Ontario, Canada, where reducing hospital readmissions has not had a policy incentive.
Key Points
- To examine temporal trends in readmission and mortality rates after hospitalization for acute myocardial infarction and heart failure in Ontario, Canada, a system without financial penalties for hospital readmissions.
- Population-based cohort study examining adults aged 65 years and older hospitalized between 2006 and 2017 with acute myocardial infarction (N=152,808) or heart failure (N=223,283).
- Assessed adjusted monthly trends for primary outcomes of 30-day readmission and 30-day post-discharge mortality, as well as in-hospital mortality metrics.
- For acute myocardial infarction, risk-adjusted 30-day readmissions fell from 17.4% in 2006 to 14.7% in 2017, and 30-day post-discharge mortality declined from 5.1% to 4.4%.
- For heart failure, risk-adjusted 30-day readmissions remained flat at 21.9% from 2006 to 2014 before decreasing to 20.8% in 2017, while 30-day post-discharge mortality declined from 7.1% to 6.6%.
- Overall age- and sex-standardized hospitalizations decreased 32% for acute myocardial infarction and 9.1% for heart failure over the 11-year period.
Study Design
Type
Cohort (n=376,091)
Multicenter
Yes
Structured PICO
P
Population
376,091 patients aged 65 years or older hospitalized for acute myocardial infarction (152,808) or heart failure (223,283) in Ontario, Canada, between 2006 and 2017.
O
Outcome
30-day readmission and 30-day post-discharge mortalityhard clinical
Main Result
Absolute Event Rate: 14.7% vs 17.4%
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Concordant with the United States, there were significant reductions in admission rates, risk-adjusted readmissions, and mortality in patients with AMI. However, whereas the United States observed a large reduction in admission and readmission and a slight increase in postdischarge mortality among patients with HF, Ontario only experienced smaller declines in admission and readmission over time, but a qualitatively different result for mortality. The reasons underlying the diverging country-specific patterns for patients with HF are not clear, but should be concerning for the United States, who have had a trend of increasing postdischarge HF mortality since 2006 which preceded the readmission program.”
Implication
In Ontario, Canada, despite the absence of policy financial incentives targeting readmissions, hospitalization, 30-day readmission, and 30-day mortality rates for both AMI and HF declined between 2006 and 2017.
Abstract
BACKGROUND Readmission rates after acute myocardial infarction (AMI) and heart failure (HF) hospitalizations have decreased in the United States since the implementation of the Hospital Readmissions Reduction Program. OBJECTIVES This study was designed to examine the temporal trends of readmission and mortality after AMI and HF in Ontario, Canada, where reducing hospital readmissions has not had a policy incentive. METHODS The cohort was comprised of AMI or HF patients 65 years of age or older who had been hospitalized from 2006 to 2017. Primary outcomes were 30-day readmission and post-discharge mortality. Secondary outcomes included in-hospital mortality, 30-day mortality from admission, and in-hospital mortality or 30-day mortality post-discharge. Adjusted monthly trends for each outcome were examined over the study period. RESULTS Our cohorts included 152,808 AMI and 223,283 HF patients. Age- and sex-standardized AMI hospitalization rates in Ontario declined 32% from 2006 to 2017 while HF hospitalization rates declined slightly (9.1%). For AMI, risk-adjusted 30-day readmission rates declined from 17.4% in 2006 to 14.7% in 2017. All AMI risk-adjusted mortality rates also declined from 2006 to 2017 with 30-day post-discharge mortality from 5.1% to 4.4%. For HF, overall risk-adjusted 30-day readmission was largely unchanged from 2006 to 2014 at 21.9%, followed by a decline to 20.8% in 2017. Risk-adjusted 30-day post-discharge mortality declined from 7.1% in 2006 to 6.6% in 2017. CONCLUSIONS The patterns of outcomes in Ontario are consistent with the United States for AMI, but diverge for HF. For AMI and HF, admissions, readmissions, and mortality rates declined over this period. The reasons for the country-specific patterns for HF need further exploration.
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Cite This Study
Ko et al. (2020) conducted a cohort in Acute myocardial infarction and heart failure (n=376,091). Hospitalization for AMI or HF in a health system without policy incentives for readmission reduction (2017 vs 2006) vs. Baseline year (2006) was evaluated on 30-day readmission and 30-day post-discharge mortality. Hospitalizations for AMI and HF in Ontario showed declining 30-day readmissions (AMI: 17.4% to 14.7%; HF: 21.9% to 20.8%) and post-discharge mortality (AMI: 5.1% to 4.4%; HF: 7.1% to 6.6%) by 2017.