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In Heart Failure, Discharges Earlier, Readmission Rates Up

Discharges to skilled nursing homes increase, while in-hospital mortality falls

TUESDAY, June 1 (HealthDay News) -- Patients admitted to hospitals for heart failure in 2006 fared better in-hospital than did those in 1993, but were discharged more often to nursing homes, and readmitted more frequently, according to research published in the June 2 issue of the Journal of the American Medical Association.

Héctor Bueno, M.D., of the Hospital General Universitario Gregorio Marañón in Madrid, Spain, and colleagues conducted an observational study of 6,955,461 Medicare hospitalizations for heart failure in the United States between 1993 and 2006. The researchers aimed to determine whether known decreases in hospital length-of-stay over the past decade would equate to changes in heart failure outcomes.

Over the study period, the researchers found that the mean length-of-stay decreased from 8.81 to 6.33 days, and in-hospital mortality decreased from 8.5 to 4.3 percent. Discharges directly to skilled nursing facilities -- as opposed to discharges to home, with or without home care services -- increased by 53 percent. Thirty-day mortality decreased slightly, from 12.8 to 10.7 percent, but post-discharge mortality (mortality from discharge up to 30 days after admission) increased by 2.1 percent. Compared with 1993 to 1994, in 2005 to 2006, the 30-day readmission risk ratio was 1.11.

"Although the 30-day mortality rate has decreased, the increase in readmission rates that paralleled the decrease in length of stay does raise concerns -- as does the increase in the rates of discharge to nursing home facilities," the authors write. "Our study also indicates the importance of examining an episode of acute care during a standardized period of assessment rather than merely focusing on the hospitalization."

Two authors disclosed financial relationships with the pharmaceutical industry.

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