Heart failure readmission after mitral valve repair and replacement: Five-year follow-up in the medicare population

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Abstract

Background. Readmission rates are well established as a quality indicator for heart failure (HF). We analyzed HF readmission rates after mitral valve repair (MVP) and replacement (MVR). Methods. We included 21,138 Medicare beneficiaries with primary isolated MVP (n = 6,896) or MVR (n = 14,242) from 2000 through 2004. Readmission rates were identified using MedPar records subsequent to the index procedure during a 5-year follow-up. Treating death as a competing risk, cumulative readmission incidences were analyzed and stratified by presence or absence of preoperative HF. Results. Preoperative HF was present in 61.0% of the patients. All-cause readmission rates were 24.9% at 30 days and 78.0% at 5 years. The cumulative incidence of readmission for HF remained almost 3 times higher in patients with preoperative HF compared with those without for MVP (2.1% vs 5.9% in 30 days and 10.3% vs 26.3% in 5 years) and 2 times higher for MVR (3.6% vs 7.4% in 30 days and 15.8% vs 30.4% in 5 years). Regardless of procedure type, patients without preoperative HF had significantly lower HF readmission rates (3.0% vs 7.0% in the first 30 days and 13.6% vs 29.2% after 5 years) ( p = 0.0001). Conclusions. Hospital readmission after mitral surgery is high. Preoperative heart failure is associated with higher postoperative readmission rates. Because admission for heart failure accounts for a significant proportion of these readmissions, close follow-up of patients with known mitral valve disease and referral to surgery prior to development of heart failure may decrease post-operative readmission rates.

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Vassileva, C. M., Ghazanfari, N., Spertus, J., McNeely, C., Markwell, S., & Hazelrigg, S. (2014). Heart failure readmission after mitral valve repair and replacement: Five-year follow-up in the medicare population. Annals of Thoracic Surgery, 98(5), 1544–1550. https://doi.org/10.1016/j.athoracsur.2014.07.040

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