Abstract 19554: Cardiologist Involvement in Heart Failure Hospitalizations is Associated with Reduced Rates of Readmissions and Increased Severity of Illness
Background: Congestive Heart Failure (CHF) is the most common cause for hospital readmission in patients over the age of 65 years. Whereas, efforts to reduce readmission rates have focused on transitions of care and short-term outpatient follow-up, limited data exist on the impact of specialist care during the index admission in reducing readmission rates.
Methods: All CHF admissions between January 1, 2009 and December 31, 2011 were identified retrospectively by primary discharge codes. Patient demographics, length of stay (LOS), time to readmission, all patient refined diagnosis related groups (APRDRG), hospital attending at time of discharge, and total hospital costs were abstracted and analyzed based on the attending provider at discharge. Because traditional methods for standardization/transformation of data were insufficient to adjust for patient APRDRG, bootstrapping was employed.
Results: Among 2311 patients (median age 75, 49.9% male), 1505 (65%) patients were treated by a Hospitalist attending, whereas, the remaining 808 (35%) patients were treated by a Cardiologist attending. 535 (23.2%) patients were readmitted within 30 days of discharge. Readmission rates were significantly lower when the attending was a cardiologist as compared to a hospitalist (16.0% [95% CL: 12.3%, 20.8%] vs. 27.1% [95% CL: 24.9%, 29.4%]; p<0.001). The APRDRG geometric mean for patients with a cardiologist either as consultant or attending was 1.80 (95% CL: 1.74, 1.87) and 1.02 (95% CL: 0.98, 1.05) for those without (p<0.001), indicating cardiologists were seeing higher severity cases. Median LOS was similar between attending cardiologists and hospitalists (4.8 days vs. 4.2 days; p=0.60). Adjusting for APRDRG, mean total costs for patients treated by a cardiologist were higher than those treated by a hospitalist ($9850 [95% CL: $9614, $10093] vs. $7741 [95% CL: $7560, $7926]; p<0.001).
Conclusions: Reduced rates of hospital readmissions despite an increased severity of illness among patients with a cardiologist as the attending compared to those with a hospitalist attending highlights the value of specialized care in heart failure treatment. Additionally, total costs for patients treated by cardiologists are likely over-stated due to interventional charges.
- © 2012 by American Heart Association, Inc.