Rehospitalization for Heart Failure

Abstract

Heart failure is the leading cause of hospitalization among adults {>}65 years of age in the United States. Annually, {>}1 million patients are hospitalized with a primary diagnosis of heart failure, accounting for a total Medicare expenditure exceeding $17 billion.1 Despite dramatic improvement in outcomes with medical therapy,2,3 admission rates following heart failure hospitalization remain high,4 with ≥50% patients readmitted to hospital within 6 months of discharge.5–7 Because reduction in readmission rates might simultaneously reduce costs and improve quality of care, public and private payers have increasingly targeted readmissions as a focus of pay-for-performance initiatives.8 In 2009, the US Center for Medicare & Medicaid Services began public reporting of all-cause readmission rates after heart failure hospitalization, and, in the following year, the Patient Protection and Affordable Care Act9 established financial penalties for hospitals with the highest readmission rates during the first 30 days after discharge. Increasing concern regarding the need to reduce readmissions has focused national research and hospital-driven efforts on the prediction of which patients with heart failure are likely to be readmitted and the design of interventions to prevent readmissions. Discharge from a heart failure hospitalization is followed by a readmission within 30 days in ≈24% of cases.5 Recurrent heart failure and related cardiovascular conditions account for only about half of readmissions in patients with heart failure, whereas other comorbid conditions account for the rest.10 Although the proportion of noncardiovascular admissions is higher in those with preserved ejection fraction (EF),11 overall readmission rates for heart failure remain similar whether the heart failure occurs with reduced or preserved EF.12 The rate and characteristics of readmission for patients with an initially low EF that recovers to ≥40% (heart failure with ‘better' EF) are yet to be …