Abstract 17391: Effect of Advanced Heart Failure Care on the Risk of Early Readmission
Introduction: Risk adjusted rates of 30-day readmission (30DR) for heart failure (HF) have been publicly reported since 2008 and are included in the Medicare Shared Savings Program for Accountable Care Organizations. Whether the risk represented by HF patients followed in Advanced Heart Failure Programs (AHFP) offering LVAD and heart transplantation (HTX) services is adequately adjusted using the CMS model is unknown. To examine this issue, we sought to compare readmission risk and comorbidity distributions in patients under evaluation for LVAD or HTX and in patients followed by the AHFP at our institution.
Methods: We collected data on patients discharged from the University of Michigan Hospital with a HF DRG from July, 2008 to November, 2010. Data collection included comorbidities used in the CMS risk model and laboratory values. LVAD and HTX evaluation status and discharging service type were determined. Patients < 19 years old and those expiring in the hospital were excluded from the analysis.
Result: A total of 1412 patients admitted for HF were analyzed in this sample (30DR 27%). Patients under evaluation for LVAD or HTX trended to have higher 30DR compared to other patients (34.5% vs 26.4%, p=0.06). Predicted probability of readmission for the AHFP team (n=407) was higher than other services (0.230±0.002 vs 0.218±0.002, p<0.001), but 30DR was similar for the two groups (27.8% vs 26.8%, p=0.70). Logistic regression analysis, controlling for variables included in the CMS risk model and laboratory values, demonstrated that patients under evaluation for LVAD or HTX were more likely to experience 30DR (OR 1.76, 95% CI 1.10-2.82, p=0.018) while patients treated on the AHFP service were less likely to experience 30DR (OR 0.74, 95% CI 0.55-0.99, p=0.047).
Conclusion: HF patients treated in our AHFP have higher predicted probability of readmission compared to those admitted to general cardiology or medicine services. Patients under evaluation for LVAD or HTX have a higher risk of readmission, and when controlling for these patients, our AHFP service demonstrated a reduced risk of early readmission compared to other services. Further study is needed to determine what elements of care provided through the AHFP are responsible for this reduced readmission risk.
- © 2011 by American Heart Association, Inc.