Medicare patients with heart failure are experiencing shorter hospital stays and are increasingly likely to be discharged to skilled nursing facilities. While short-term mortality rates have improved, hospital readmission rates and overall mortality risk are higher.
New drugs and devices have improved outcomes for cardiac patients over the long term, but no parallel progress has been observed in acute care. The most prominent change in acute care for patients with heart failure (HF) over the past decade has been a decrease in length of hospital stay. The objective of this observational study is to describe the temporal changes in length of stay, discharge disposition, and short-term outcomes among older patients hospitalized for HF. The authors analyzed Medicare data on 6,955,461 hospitalizations for HF between 1993 and 2006.
- Mean length of stay decreased by 2.5 days, discharges to skilled nursing facilities increased by 53 percent and discharges to home decreased by 10 percent.
- Post-discharge mortality (within the first 30 days) increased by 2.1 percent.
- 30-day readmission rate increased.
The pattern of care during hospitalization and immediately afterward for older patients with HF has changed substantially in U.S. over the14 years studied, but it is not clear that care was markedly better in 2006 than it was in 1993. One limitation of this study is the reliance on administrative data, which precludes consideration of clinically relevant factors, as well as evaluation of both the quality of care and the rate of premature discharge.