Heart Failure Mortality Decreases While Rehospitalization Increases among Veterans
FINDINGS:
- Mortality and rehospitalization rates for Veterans with a first hospitalization for heart failure in the VA healthcare system or in a non-VA hospital that was paid for by VA trended in opposite directions between 2002 and 2006. Mortality rates at 30 days decreased (7.1% to 5.0%), while rehospitalization rates for heart failure at 30 days increased (5.6% to 6.1%).
- Over the same time period, use of guideline recommended therapy increased. During the six months prior to hospital admission and during the three months following admission, there were large increases in the use of beta-blockers. The use of angiotensin-receptor blockers also increased.
- Examination of patient characteristics showed that most comorbid diagnoses increased significantly from 2002 to 2006, suggesting that Veterans hospitalized in 2006 were more ill.
- The results of these analyses using VA data are similar to those of published studies that use non-VA data.
- The authors suggest that the use of rehospitalization for heart failure as a marker of poor care may be flawed. Further studies to determine the reasons for the decline in mortality and the portion of hospitalizations that are preventable are recommended.
BACKGROUND:
Heart failure is the number one reason for admission among Veterans enrolled in the VA healthcare system. In order to improve care for this chronic disease, VA has incorporated the use of guideline-recommended treatments; however, it is unclear if the increased performance on process of care measures for hospitalized Veterans has led to improvements in outcomes. This study sought to determine if recent mortality and readmission rates have improved within VA. Using VA data, investigators identified 50,125 Veterans with a first hospitalization (including non-VA hospitalization paid for by VA) for heart failure from 2002 to 2006 and examined 30-day rehospitalization for heart failure, and 30-day mortality following discharge. In addition, they assessed patient characteristics and guideline-recommended medication usage.
LIMITATIONS:
- Rehospitalization data were incomplete, as investigators could not determine trends in non-VA readmissions for Veterans with heart failure that were not paid for by VA.
- There were no data on cause of death, and it is possible that trends in mortality from heart failure may have differed from trends in mortality from other causes.
AUTHOR/FUNDING INFORMATION:
This study was funded through VA/HSR&D’s Chronic Heart Failure Quality Enhancement Research Initiative (CHF-QUERI). Drs. Heidenriech, Sahay, and Massie are part of CHF-QUERI.
Heidenreich P, Sahay A, Kapoor J, Pham M, and Massie B. Divergent Trends in Survival and Readmission Following a Hospitalization for Heart Failure in the Veterans Affairs Health Care System 2002 to 2006. Journal of the American College of Cardiology July 27, 2010;56(5):362-68.
