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Harlan M. Krumholz, MD; Eugene M. Parent, MD; Nora Tu, MS; Viola Vaccarino, MD; Yun Wang, MS; Martha J. Radford, MD; John Hennen, PhD

Arch Intern Med. 1997;157(1):99-104.

Abstract
Background
Congestive heart failure is the most common discharge diagnosis for Medicare beneficiaries. While several single-center studies have suggested that these patients are particularly vulnerable to readmission, no recent study, to our knowledge, has reported the readmission rates for a large number of elderly patients with congestive heart failure across a diverse spectrum of hospitals.

Objectives
To define the readmission rate for elderly patients discharged after an episode of congestive heart failure. To determine the spectrum of diagnoses that are responsible for readmissions among patients with congestive heart failure. To identify patient and hospital characteristics associated with a higher likelihood of readmission.

Methods
This observational study, using Medicare administrative files, evaluated readmission and death among all survivors of a hospitalization in Connecticut for congestive heart failure from fiscal year 1991 through fiscal year 1994.

Results
There were 17448 survivors of a hospitalization for congestive heart failure during the study period. In the 6 months following the index admission, 7596 patients (44%) were readmitted to a hospital at least once. Congestive heart failure was the most frequent reason for readmission among study patients, accounting for 18% of all readmissions. In the multivariable analysis, significant predictors of readmission included male sex (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.05-1.20), at least 1 prior admission within 6 months of the index admission (OR, 1.64; 95% CI, 1.53-1.77), Deyo comorbidity score of more than 1 (OR, 1.56; 95% CI, 1.45-1.68), and length of stay in the index hospitalization of more than 7 days (OR, 1.32; 95% CI, 1.24-1.41). While age was not a significant predictor of readmission, it became significant in a model with the combined outcome of readmission or death as the dependent variable.

Conclusion
Readmission after a hospitalization for congestive heart failure is common among Medicare beneficiaries, with almost half of the patients readmitted within 6 months. This striking rate of readmission in a common diagnosis demands efforts to further clarify the determinants of readmission and develop strategies to prevent this adverse outcome.

Arch Intern Med. 1997;157:99-104

Author Affiliations
From the Section of Cardiovascular Medicine, Department of Medicine, the Section of Chronic Disease Epidemiology, Department of Epidemiology and Public Health, Yale School of Medicine, and the Yale—New Haven Center for Outcomes Research and Evaluation, New Haven, Conn (Drs Krumholz, Parent, and Vaccarino); Connecticut Peer Review Organization, Middletown (Drs Krumholz, Vaccarino, Radford, and Hennen, Ms Tu, and Mr Wang); and Cardiology Division, University of Connecticut Medical School, Farmington (Dr Radford).

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