Dennis T Ko1, Rohan Khera2, Geoffrey Lau3, Feng Qiu3, Yongfei Wang4, Peter C Austin3, Maria Koh3, Zhenqiu Lin5, Douglas S Lee6, Harindra C Wijeysundera7, Harlan M Krumholz8. 1. Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Electronic address: dennis.ko@ices.on.ca. 2. University of Texas Southwestern Medical Center, Dallas, Texas. 3. ICES, Toronto, Ontario, Canada. 4. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut. 5. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut. 6. ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada. 7. Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 8. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
Abstract
BACKGROUND: Readmission rates after acute myocardial infarction (AMI) and heart failure (HF) hospitalizations have decreased in the United States since the implementation of the Hospital Readmissions Reduction Program. OBJECTIVES: This study was designed to examine the temporal trends of readmission and mortality after AMI and HF in Ontario, Canada, where reducing hospital readmissions has not had a policy incentive. METHODS: The cohort was comprised of AMI or HF patients 65 years of age or older who had been hospitalized from 2006 to 2017. Primary outcomes were 30-day readmission and post-discharge mortality. Secondary outcomes included in-hospital mortality, 30-day mortality from admission, and in-hospital mortality or 30-day mortality post-discharge. Adjusted monthly trends for each outcome were examined over the study period. RESULTS: Our cohorts included 152,808 AMI and 223,283 HF patients. Age- and sex-standardized AMI hospitalization rates in Ontario declined 32% from 2006 to 2017 while HF hospitalization rates declined slightly (9.1%). For AMI, risk-adjusted 30-day readmission rates declined from 17.4% in 2006 to 14.7% in 2017. All AMI risk-adjusted mortality rates also declined from 2006 to 2017 with 30-day post-discharge mortality from 5.1% to 4.4%. For HF, overall risk-adjusted 30-day readmission was largely unchanged from 2006 to 2014 at 21.9%, followed by a decline to 20.8% in 2017. Risk-adjusted 30-day post-discharge mortality declined from 7.1% in 2006 to 6.6% in 2017. CONCLUSIONS: The patterns of outcomes in Ontario are consistent with the United States for AMI, but diverge for HF. For AMI and HF, admissions, readmissions, and mortality rates declined over this period. The reasons for the country-specific patterns for HF need further exploration.
BACKGROUND: Readmission rates after acute myocardial infarction (AMI) and heart failure (HF) hospitalizations have decreased in the United States since the implementation of the Hospital Readmissions Reduction Program. OBJECTIVES: This study was designed to examine the temporal trends of readmission and mortality after AMI and HF in Ontario, Canada, where reducing hospital readmissions has not had a policy incentive. METHODS: The cohort was comprised of AMI or HFpatients 65 years of age or older who had been hospitalized from 2006 to 2017. Primary outcomes were 30-day readmission and post-discharge mortality. Secondary outcomes included in-hospital mortality, 30-day mortality from admission, and in-hospital mortality or 30-day mortality post-discharge. Adjusted monthly trends for each outcome were examined over the study period. RESULTS: Our cohorts included 152,808 AMI and 223,283 HFpatients. Age- and sex-standardized AMI hospitalization rates in Ontario declined 32% from 2006 to 2017 while HF hospitalization rates declined slightly (9.1%). For AMI, risk-adjusted 30-day readmission rates declined from 17.4% in 2006 to 14.7% in 2017. All AMI risk-adjusted mortality rates also declined from 2006 to 2017 with 30-day post-discharge mortality from 5.1% to 4.4%. For HF, overall risk-adjusted 30-day readmission was largely unchanged from 2006 to 2014 at 21.9%, followed by a decline to 20.8% in 2017. Risk-adjusted 30-day post-discharge mortality declined from 7.1% in 2006 to 6.6% in 2017. CONCLUSIONS: The patterns of outcomes in Ontario are consistent with the United States for AMI, but diverge for HF. For AMI and HF, admissions, readmissions, and mortality rates declined over this period. The reasons for the country-specific patterns for HF need further exploration.
Authors: Karola S Jering; Claudio Campagnari; Brian Claggett; Eric Adler; Liviu Klein; Faraz S Ahmad; Adriaan A Voors; Scott Solomon; Avi Yagil; Barry Greenberg Journal: Eur J Heart Fail Date: 2022-05-22 Impact factor: 17.349
Authors: Lotte Verweij; Denise F Spoon; Michel S Terbraak; Patricia Jepma; Ron J G Peters; Wilma J M Scholte Op Reimer; Corine H M Latour; Bianca M Buurman Journal: J Adv Nurs Date: 2021-02-17 Impact factor: 3.187
Authors: Dennis T Ko; Tareq Ahmed; Peter C Austin; Warren J Cantor; Paul Dorian; Michael Goldfarb; Yanyan Gong; Michelle M Graham; Jing Gu; Nathaniel M Hawkins; Thao Huynh; Karin H Humphries; Maria Koh; Yoan Lamarche; Laurie J Lambert; Patrick R Lawler; Jean-Francois Légaré; Hung Q Ly; Feng Qiu; Ata Ur Rehman Quraishi; Derek Y So; Robert C Welsh; Harindra C Wijeysundera; Graham Wong; Andrew T Yan; Yana Gurevich Journal: CJC Open Date: 2021-05-01
Authors: Stephanie Poon; Benjamin Leis; Laurie Lambert; Kendra MacFarlane; Kim Anderson; Claudia Blais; Catherine Demers; Justin A Ezekowitz; Nathaniel M Hawkins; Douglas S Lee; Gordon Moe; Roopinder K Sandhu; Sean A Virani; Stephen Wilton; Shelley Zieroth; Robert McKelvie Journal: CJC Open Date: 2022-08-12
Authors: My Hanh Bui; Quynh Long Khuong; Phuoc Thang Dao; Cao Phuong Duy Le; The Anh Nguyen; Binh Giang Tran; Duc Hung Duong; Tuan Duc Duong; Tien Hung Tran; Hoang Ha Pham; Xuan Thanh Dao; Quang Cuong Le Journal: Front Public Health Date: 2021-12-10