Readmissions and the quality of care in patients hospitalized with heart failure

• Published in: International journal for quality in health care 2003-10, Vol.15 (5), p.413-421
• Main Authors: Luthi, Jean-Christophe, Lund, Mary Jo, Sampietro-Colom, Laura, Kleinbaum, David G., Ballard, David J., McClellan, William M.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; angiotensin-converting enzyme inhibitors; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Cohort Studies; Comorbidity; Female; Guideline Adherence; heart failure; Heart Failure - drug therapy; Heart Failure - etiology; Hospitals, Community - statistics & numerical data; Humans; left ventricular systolic dysfunction; Length of Stay - statistics & numerical data; Male; Medicare; Middle Aged; Outcome and Process Assessment (Health Care) - statistics & numerical data; outcome assessment; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Quality Indicators, Health Care - statistics & numerical data; quality of health care; readmissions; Smoking; United States; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - drug therapy
• ISSN: 1353-4505; 1464-3677
• DOI: 10.1093/intqhc/mzg055

Objectives. Clinical practice guidelines based on the results of randomized clinical trials recommend that patients with heart failure due to left ventricular systolic dysfunction (LVSD) be treated with angiotensin-converting enzyme inhibitors (ACEI) at doses shown to reduce mortality and readmission. This study examined the relationship between ACEI use at discharge and readmission among patients with heart failure due to LVSD. Methods and results. Data were abstracted from the medical records of 2943 randomly selected patients hospitalized for heart failure in 50 hospitals. The outcome of interest was the number of readmissions occurring up to 21 months after discharge. Six-hundred and eleven patients were eligible for analysis. Compared with patients discharged at a recommended ACEI dose, patients not prescribed an ACEI at discharge had an adjusted rate ratio of readmission (RR) of 1.74 [95% confidence interval (CI) 1.22–2.48], while patients prescribed an ACEI at less than a recommended dose had an RR of 1.24 (95% CI 0.91–1.69) (P = 0.005 for the trend). Conclusion. Our results show that ACEI use at discharge in patients with LVSD is associated with decreased rate of readmission. These findings suggest that compliance with the ACEI prescribing recommendations listed in clinical practice guidelines for patients with heart failure due to LVSD confers benefit.