Abstract 181: Relationship Between 30-Day Readmission and 30-Day Mortality for Heart Failure and Acute Myocardial Infarction.

Abstract

Background: Mortality and readmission at 30 days following admission for heart failure (HF) and acute myocardial infarction (AMI) are publically reported. It is unclear if these are influenced by similar (correlated) or different care processes (not correlated). Methods: We used publically available data from Hospital Compare of the Center for Medicare and Medicaid Services that includes hospital specific 30-day mortality and 30-day all-cause readmission rates adjusted for patient characteristics for US hospitals from 2010-2011. In multivariate analyses of 30-day outcome we included hospital level rates of the HF and AMI rates of process of care reported on Hospital Compare, hospital type (critical access vs. other) and used backward selection to determine those characteristics associated with outcome (p<0.05). All analyses were weighted for the number of discharges per facility. Results: There was a slight negative correlation (r= -0.17, p< 0.0001) for HF (hospitals with lower mortality had more readmissions, N=3990) and no correlation (r= 0.01, p=0.52) for AMI (N=2434, Figure). 30-day mortality for HF was correlated with 30-day mortality for AMI (r=0.37, p<0.0001), and a stronger correlation (r=0.50, p<0.0001) was observed for readmission (HF vs. AMI). In multivariate analysis, hospitals with a higher HF readmission rate were more likely to have a lower HF mortality rate, be a non-critical access hospital, have more documentation of discharge instructions and less documentation of ejection fraction. A higher HF mortality rate was associated with a higher HF readmission rate, less documentation of ejection fraction and hospitalization at a critical access hospital. A higher AMI readmission rate was associated with less aspirin use on arrival and longer door to balloon times. A lower AMI mortality rate was associated with more beta-blocker use and rapid door to balloon time. Conclusion: There is a slight inverse correlation for 30-day readmission and 30-day mortality following an admission for HF but not for AMI. Associations of recommended processes of care with less readmission were limited but consistent for AMI. Disparate associations were noted for HF readmission and processes of care.