Mortality and Readmission Rates in Patients Hospitalized for Acute Decompensated Heart Failure

A Comparison between Cardiology and General-Medicine Service Outcomes in an Underserved Population

Ahmed M. Selim, Jeremy A. Mazurek, Muhammad Iqbal, Dan Wang, Abdissa Negassa, Ronald Zolty

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: With recent legislation imposing penalties on hospitals for above-average 30-day all-cause readmissions for patients with acute decompensated heart failure (ADHF), there is concern these penalties will more heavily impact hospitals serving socioeconomically vulnerable and underserved populations. Hypothesis: Patients with ADHF and low socioeconomic status have better postdischarge mortality and readmission outcomes when cardiologists are involved in their in-hospital care. Methods: We retrospectively searched the electronic medical record for patients hospitalized for ADHF from 2001 to 2010 in 3 urban hospitals within a large university-based health system. These patients were divided into 2 groups based on whether a cardiologist was involved in their care or not. Measured outcomes were 30- and 60-day postdischarge mortality and readmission rates. Results: Out of the 7516 ADHF patients, 1434 patients were seen by a cardiologist (19%). These patients had lower 60-day mortality (5.4% vs 7.0%; hazard ratio [HR]: 0.70, 95% confidence interval [CI]: 0.52-0.96, P = 0.034) and lower 30- and 60-day readmission rates (16.7% vs 20.6%; HR: 0.76, 95% CI: 0.66-0.89, P = 0.002, and 26.1% vs 30.2%; HR: 0.81, 95% CI: 0.72-0.92, P = 0.003, respectively). There was no significant difference in the in-hospital mortality between the 2 groups. Compared with other races, whites with systolic HF have marginally lower HF-related readmission rates when treated by cardiologists. Conclusions: In this cohort of ADHF patients from the Bronx, New York, involvement of a cardiologist resulted in improved short-term mortality and readmission outcomes compared with treatment by general internal medicine.

Original languageEnglish (US)
Pages (from-to)131-138
Number of pages8
JournalClinical Cardiology
Volume38
Issue number3
DOIs
StatePublished - Mar 1 2015

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Vulnerable Populations
Cardiology
Heart Failure
Medicine
Mortality
Confidence Intervals
Patient Readmission
Electronic Health Records
Urban Hospitals
Internal Medicine
Hospital Mortality
Legislation
Social Class
Cardiologists
Health

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Mortality and Readmission Rates in Patients Hospitalized for Acute Decompensated Heart Failure : A Comparison between Cardiology and General-Medicine Service Outcomes in an Underserved Population. / Selim, Ahmed M.; Mazurek, Jeremy A.; Iqbal, Muhammad; Wang, Dan; Negassa, Abdissa; Zolty, Ronald.

In: Clinical Cardiology, Vol. 38, No. 3, 01.03.2015, p. 131-138.

Research output: Contribution to journalArticle

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abstract = "Background: With recent legislation imposing penalties on hospitals for above-average 30-day all-cause readmissions for patients with acute decompensated heart failure (ADHF), there is concern these penalties will more heavily impact hospitals serving socioeconomically vulnerable and underserved populations. Hypothesis: Patients with ADHF and low socioeconomic status have better postdischarge mortality and readmission outcomes when cardiologists are involved in their in-hospital care. Methods: We retrospectively searched the electronic medical record for patients hospitalized for ADHF from 2001 to 2010 in 3 urban hospitals within a large university-based health system. These patients were divided into 2 groups based on whether a cardiologist was involved in their care or not. Measured outcomes were 30- and 60-day postdischarge mortality and readmission rates. Results: Out of the 7516 ADHF patients, 1434 patients were seen by a cardiologist (19{\%}). These patients had lower 60-day mortality (5.4{\%} vs 7.0{\%}; hazard ratio [HR]: 0.70, 95{\%} confidence interval [CI]: 0.52-0.96, P = 0.034) and lower 30- and 60-day readmission rates (16.7{\%} vs 20.6{\%}; HR: 0.76, 95{\%} CI: 0.66-0.89, P = 0.002, and 26.1{\%} vs 30.2{\%}; HR: 0.81, 95{\%} CI: 0.72-0.92, P = 0.003, respectively). There was no significant difference in the in-hospital mortality between the 2 groups. Compared with other races, whites with systolic HF have marginally lower HF-related readmission rates when treated by cardiologists. Conclusions: In this cohort of ADHF patients from the Bronx, New York, involvement of a cardiologist resulted in improved short-term mortality and readmission outcomes compared with treatment by general internal medicine.",
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