Abstract 15818: Continued Falls in First Hospitalization for Heart Failure but Little Improvement in 30 Day Readmission Rates in the Scottish Population

Abstract

Background: To determine whether admission and readmission rates for heart failure (HF), and associated survival, are improving at a population level.

Methods and Results: All patients in Scotland hospitalized with an episode of HF between 1986 and 2008 were followed to death or September 30 2010. To examine survival trends over time, we adjusted for prognostic variables (including age, co-morbidities and socioeconomic status) in multivariable Cox models. From 1986 to 2008, there were 219,454 discharges for HF (50% women) and 141,923 individuals (52.2% women) had a first hospital discharge for HF. The age adjusted rate of total hospitalizations for HF (per 100,000 population) fell from 172 (95%CI 167-178) to 147(143-152) from 1986 to 2008 in men despite rising between 1986 and 1994. In a similar pattern in women, the rate fell from 168(163-173) to 128(124-133). A similar rise and fall of the age adjusted rate of first hospitalization for HF in men was observed in men 110 (106-115) to 88 (84-91) and women 115 (111-120) to 84 (81-88). After a first discharge, median survival increased from 1.3 (1.1-1.5) to ≥ 2.8 years in men and from 1.3 (1.1-1.4) to 2.0 (1.7-2.2) years in women. The adjusted hazard of death at 1 year following a first discharge in 2008 (vs 1986) was 0.55 (0.50-0.61) in men and 0.71 (0.65-0.78) in women. However, 30 day readmission rates for HF rose in men from 7(6-8) to 18(17-20) in 2000 before falling to 9(8-10). In women the respective rates were 5(4-6), 11(10-13) and 6(5-7). The adjusted hazard of readmission within 30 days in 2008 (vs 1986) was 1.2(1.0-1.5) in men and 1.5(1.2-1.8) in women.

Conclusion: In men and women the rates of all and first hospitalizations for HF fell between 1986 and 2008 and survival at 1 year improved. Thirty day readmission rates rose then fell back to levels observed in 1986. Further studies are required to understand why first admission and survival rates have improved more than 30 day readmission rates.