Trends in Readmissions and Length of Stay for Patients Hospitalized With Heart Failure in Canada and the United States

IMPORTANCE Over the past decade, reducing 30-day readmission rates has been emphasized in the United States (including via the implementation of the Hospital Readmissions Reduction Program) but not Canada. OBJECTIVE To examine changes that occurred from April 1, 2005, to December 31, 2015, in the United States and Canada for hospitalization length of stay and 30-day readmission rates of patients with heart failure. DESIGN, SETTING, AND PARTICIPANTS This cohort study included patients admitted with a primary diagnosis of heart failure to Canadian and US hospitals between April 1, 2005, and December 31, 2015, using International Classification of Diseases, Ninth Revision code 428.xx and Tenth Revision code I50. The study examined secular trends in length of stay and readmissions in both countries and tested for changes after implementation of the Hospital Readmissions Reduction Program using segmented regression models and the association between length of stay and readmissions using patient-level and hospital-level multivariable logistic regression models. Data analysis was completed from February 2018 to August 2018. MAIN OUTCOMES AND MEASURES Thirty-day readmissions. RESULTS Between 2005 and 2015, mean length of stay declined marginally in Canadian hospitals (from a mean SD of 7.5 5.7 to 7.3 5.6 days; P < .001) but remained stable in US hospitals (mean SD, 4.9 3.7 days to 4.9 3.5 days). Thirty-day readmission rates declined similarly in Canada (from 4088 of 20 758 patients 19.7% to 3823 of 21 733 patients 17.6%