Diagnoses and Timing of 30-Day Readmissions After Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia

Study Questions:

What are patterns of readmission diagnoses and timing among Medicare beneficiaries readmitted within 30 days after an index hospitalization for heart failure (HF), acute myocardial infarction (MI), or pneumonia?

Methods:

This was an analysis of 2007-2009 Medicare fee-for-service claims data to identify 30-day readmission patterns after hospitalization for HF, acute MI, or pneumonia. The following outcome measures were examined: the most common readmission diagnoses occurring during cumulative periods (days 0-3, 0-7, 0-15, and 0-30) and consecutive periods (days 0-3, 4-7, 8-15, and 16-30) after hospitalization; median time to readmission for common readmission diagnoses; and the relationship between patient demographic characteristics and readmission diagnoses and timing.

Results:

There were 329,308 30-day readmissions after 1,330,157 HF hospitalizations (24.8% readmitted); 108,992 30-day readmissions after 548,834 acute MI hospitalizations (19.9% readmitted); and 214,239 30-day readmissions after 1,168,624 pneumonia hospitalizations (18.3% readmitted). The proportion of patients readmitted for the same condition was 35.2% after the index HF hospitalization, 10.0% after the index acute MI hospitalization, and 22.4% after the index pneumonia hospitalization. While the majority of readmissions occurred within 15 days of hospitalization, more than 30% of 30-day readmissions occurred during days 16-30 for all three diagnoses. Neither readmission diagnoses nor timing varied by age, sex, or race.

Conclusions:

Among Medicare beneficiaries hospitalized for HF, acute MI, or pneumonia, 30-day readmissions were frequent, often occurred within 15 days of the index hospitalization (but still through the entire 30-day period), and were frequently unrelated to the index hospitalization.

Perspective:

This analysis adds to the growing literature surrounding readmissions following HF, acute MI, or pneumonia. By showing that readmission diagnoses usually differed from the specific diagnosis responsible for index hospitalization, the authors of this analysis draw attention to the medical comorbidities that are contributing to hospital readmissions. Furthermore, the authors demonstrated that readmissions occurred throughout the 30-day period following discharge from an index hospitalization, drawing emphasis to this entire period as a time of heightened vulnerability to readmission from a spectrum of illnesses spanning different body systems. The Medicare population with HF, acute MI, and pneumonia is complex, and interventions that successfully reduce hospital-based acute care following index hospitalizations will need to be multidisciplinary and address the diversity of illnesses to which this cohort of patients is susceptible.

Clinical Topics: Arrhythmias and Clinical EP, Dyslipidemia, Heart Failure and Cardiomyopathies, EP Basic Science, Lipid Metabolism, Acute Heart Failure

Keywords: Outcome Assessment (Health Care), Myocardial Infarction, Pneumonia, Potassium Channels, Fee-for-Service Plans, Continental Population Groups, Comorbidity, Patient Discharge, Patient Readmission, Heart Failure, Cardiovascular Diseases, Medicare, Hospitalization, United States


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