Abstract 10695: Hospital Readmission for Heart Failure Following Mitral Valve Repair and Replacement: 5-Year Follow Up in the Medicare Population
Background: Readmission rates are well established as a quality indicator for heart failure (HF). We analyzed HF readmission rates following mitral valve repair (MVP) and replacement (MVR).
Methods: We included 21,138 Medicare beneficiaries with primary isolated MVP (n=6,896) or MVR (n=14,242) from 2000-2004. Readmission rates were identified using MedPar records subsequent to the index procedure during a 5-year follow-up. Treating death as a competing risk, cumulative readmission incidences were analyzed and stratified by presence or absence of preoperative HF.
Results: Preoperative HF was present in 61.0% of the patients (53.6% for MVP and 64.6% for MVR). All-cause readmission rates were 25.2% at 30 days and 78.6% at 5 years. Heart failure readmission accounted for significant portion of all cause readmissions: 22.2% of patients readmitted within 30 days had a HF readmission during that period. The cumulative incidence of readmission for HF remained almost 3 times higher in patients with preoperative HF compared to those without for MVP (2.1% vs. 6.1% in 30 days and 10.4% vs. 26.5% in 5 years) and two times higher for MVR (3.6% vs. 7.5% in 30 days and 15.8% vs. 30.8% in 5 years). Regardless of procedure type, patients without preoperative HF had a significantly lower HF readmission rates (3.0% versus 7.1% in the first 30 days and 13.7% versus 29.6% after 5 years) (p=0.0001).
Conclusion: Hospital readmission after mitral valve surgery is high. Preoperative heart failure is associated with higher postoperative readmission rates. Since admission for heart failure accounts for a significant proportion of these readmissions, close follow up of patients with known MR and referral for surgery prior to development of heart failure may decrease postoperative readmission rates.
- © 2013 by American Heart Association, Inc.