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Global Comparison of Heart Failure Patient Readmissions
Quick Takes
- Among patients with heart failure, global rates of readmissions and mortality are high.
- Significant variations in rates of poor outcomes exist between countries.
- Variations do not seem to be associated with country socioeconomic status or health care expenditure.
Study Questions:
Among patients hospitalized with heart failure (HF) globally, 1) what are the 30-day and 1-year all-cause readmission and mortality rates, 2) what variations exist between countries, and 3) what factors are associated with these variations (including country health care expenditure)?
Methods:
This systematic review and meta-analysis of studies from January 2010 to March 2021 examined rates of hospital readmissions and mortality among adult patients hospitalized with HF. Four meta-analyses were performed, assessing 30-day and 1-year outcomes for both all-cause hospital readmission and all-cause mortality. Association of these outcomes with age, sex, comorbidities, time of publication, country socioeconomic status, and country health care expenditure were assessed.
Results:
Thirty-day hospital readmission: This pooled analysis included 24 studies (18 countries; 1,417,462 patients) and demonstrated a readmission rate of 13.2% (95% confidence interval [CI], 10.5-16.1%). Rates by country varied from 1.5% (95% CI, 0.6-3.9%) to 27.6% (95% CI, 27.0-28.3%).
One-year hospital readmission: This pooled analysis included 23 studies (16 countries, 1,036,771 patients) and demonstrated a readmission rate of 35.7% (95% CI, 27.1-44.9%). Rates by country varied from 14.0% (95% CI, 12.6-15.5%) to 63.0% (95% CI, 62.9-63.1%).
Thirty-day mortality: This pooled analysis included 33 studies (24 countries; 1,445,507 patients) and demonstrated a mortality rate of 7.6% (95% CI, 6.1-9.3%). Rates by country varied from 3.3% (95% CI, 2.9-3.8%) to 17.2% (95% CI, 17.0-17.4%).
One-year mortality: This pooled analysis included 45 studies (33 countries; 1,538,776 patients) and demonstrated a mortality rate of 23.3% (95% CI, 20.8-25.9%). Rates by country varied from 8.2% (95% CI, 6.3-10.5%) to 36.9% (95% CI, 36.4-37.5%).
Variation by country: There was significant variation in outcomes between countries. These variations by country were not associated with a country’s gross domestic product (GDP), proportion of GDP for health care expenditure, or Gini coefficient (measure of income inequality). Some of the variation was associated with certain comorbid conditions.
Conclusions:
Among patients with HF, global rates of readmission and mortality are high. These rates vary considerably between countries and are not well explained by country health care expenditure.
Perspective:
The global disease burden of HF is high and current evidence shows that variations in HF outcomes exist. Better understanding of the factors that influence these differences may better allow for development of strategies to improve overall outcomes. This systematic review and meta-analysis provides important data to begin answering some of these questions. Highlighted here is both the high rates of poor outcomes and the significant variations between countries. Interestingly, some of the variation in HF outcomes could be explained by comorbidities, but not to a large degree. Also, there were no links between outcomes and a country’s economic status, health care expenditures, or measure of income inequality. While this study is limited by possible missing data, variable diagnostic criteria for HF, and lack of granular data, this should prompt further investigation into the understanding these global variations. This will allow for future efforts in addressing the global HF burden to be both effective and high value.
Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Acute Heart Failure
Keywords: Comorbidity, Global Burden of Disease, Health Expenditures, Heart Failure, Hospitalization, Patient Readmission, Socioeconomic Factors
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