Patients with heart failure may do better when readmitted to the same versus to a different hospital, according to a new study.
Researchers in Canada performed a retrospective cohort study of data on patients from nine provinces and three territories who were discharged from the hospital with a primary diagnosis of heart failure from April 2004 through December 2013. Patients who were readmitted for any cause within 30 days to the original hospital were compared with those readmitted for any cause within 30 days to a different hospital. The study's primary outcomes were length of stay and in-hospital mortality. Results were published online May 10 by the Journal of the American Heart Association.
A total of 217,039 patients were included in the study. Mean age was 76.8 years, and 50.1% were men. Of the total group, 32,771 (83.2%) were readmitted to the same hospital and 6,597 (16.8%) were readmitted to a different hospital. The percentage of patients readmitted to a different hospital increased over time, from 15.6% in 2004 to 18.5% in 2013 (P=0.001 for trend). Patients readmitted to a different hospital were more likely to be younger, to be male, to live in a rural area, to have been discharged more recently, to have had their initial admission at a teaching hospital, and to arrive at the hospital via ambulance for readmission. The top five causes for readmission were heart failure, chronic obstructive pulmonary disease, acute myocardial infarction, pneumonia, and atrial fibrillation or flutter. Patients who were readmitted to the same hospital versus a different hospital had shorter stays (10.4 days vs. 11.6 days; adjusted means, 11.0 days vs. 12.0 days; P<0.001) and lower rates of inpatient mortality (14.4% vs. 15.0%; adjusted odds ratio, 0.89 [95% CI, 0.82 to 0.96]).
The authors noted that they used administrative data to define heart failure and comorbidities and did not have data available on such variables as ejection fraction and natriuretic peptide levels or on clinical findings that would allow them to determine illness severity. In addition, they noted that data were not available on changes in outpatient resources over the study period, distance from patients' homes to the hospital, or socioeconomic factors that might have affected hospital choice and health outcomes, among other limitations. However, they concluded that based on their results, readmission to a different hospital is associated with worse outcomes for patients with heart failure, adding that it may result in duplicated tests and procedures, potential exposure to different nosocomial pathogens, and delayed diagnoses or treatments.
“We believe our study provides further support for the importance of continuity in health care and should [motivate] patients, caregivers, and their physicians to ensure follow-up after discharge occurs with healthcare providers who are familiar with them,” the authors wrote. “Our study should also motivate health system planners to conduct evaluations of ‘return to original hospital’ versus ‘take to the closest facility’ ambulance policies for [heart failure] patients who deteriorate post-discharge.”