Abstract 18094: Multimorbidity and 30-Day All-Cause Readmission Among Hospitalized Medicare Beneficiaries With Heart Failure

Abstract

Background: According to the Centers for Medicare and Medicaid Services (CMS), Medicare beneficiaries with ≥6 chronic conditions have the highest (25%) 30-day all-cause readmission rate (Chronic Conditions among Medicare Beneficiaries, Chartbook, 2012). Heart failure (HF) is the only single chronic condition with similarly high 30-day all-cause readmission rates (PMID: 19339721). In the current analysis, we examined the additional impact of comorbidity burden on 30-day all-cause readmission in patients with HF. Methods: We analyzed data from 8049 Medicare beneficiaries discharged alive from 106 U.S. hospitals during 1998-2001. We identified 14 chronic medical conditions used by the CMS (HF being index condition in the current analysis) and categorized patients into 0 (n=123), 1 (n=533), 2 (1395), 3 (n=2016), 4 (n=1986) and ≥5 (n=1996) comorbidities. Because the incidence of 30-day all-cause readmission was similar for those with 0-3 morbidities (20%, 16%, 18% and 18%, respectively; overall, 18%), we combined these 4 groups and used them as reference to estimate age-sex-race-adjusted hazard ratios (HR) for those with 4 and ≥5 comorbidities using Cox regression models. Results: Patients had a mean age of 76 (±11) years, 58% were women, and 25% were African American. Age-sex-race-adjusted associations of 4 and ≥5 comorbidities with outcomes are displayed in the Table below. Conclusions: For hospitalized older patients with HF, the risk of 30-day all-cause readmission was comparable for those with 0-3 comorbidities, which progressively increased for those with 4 and ≥5 comorbidities. However, comorbidity burden seems to have a modest association with 30-day all-cause mortality. These findings suggest that the CMS’s chronic condition list may be used to identify hospitalized older HF patients at higher risk for 30-day all-cause readmission, a current target of health care reform which could reduce costs for Medicare. _