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Early and Long-term Outcomes of Heart Failure in Elderly Persons, 2001-2005
Lesley H. Curtis, PhD;
Melissa A. Greiner, MS;
Bradley G. Hammill, MS;
Judith M. Kramer, MD, MS;
David J. Whellan, MD, MHS;
Kevin A. Schulman, MD;
Adrian F. Hernandez, MD, MHS
Arch Intern Med. 2008;168(22):2481-2488.
Background The treatment of chronic heart failure has improved during the past 2 decades, but little is known about whether the improvements are reflected in trends in early and long-term mortality and hospital readmission.
Methods In a retrospective cohort study of 2 540 838 elderly Medicare beneficiaries hospitalized with heart failure between January 1, 2001, and December 31, 2005, we examined early and long-term all-cause mortality and hospital readmission and patient- and hospital-level predictors of these outcomes.
Results Unadjusted in-hospital mortality declined from 5.1% to 4.2% during the study (P < .001), but 30-day, 180-day, and 1-year all-cause mortality remained fairly constant at 11%, 26%, and 37%, respectively. Nearly 1 in 4 patients were readmitted within 30 days of the index hospitalization, and two-thirds were readmitted within 1 year. Controlling for patient- and hospital-level covariates, the hazard of all-cause mortality at 1 year was slightly lower in 2005 than in 2001 (hazard ratio, 0.98; 95% confidence interval, 0.97-0.99). The hazard of readmission did not decline significantly from 2001 to 2005 (hazard ratio, 0.99; 95% confidence interval, 0.98-1.00).
Conclusions Early and long-term all-cause mortality and hospital readmission rates remain high and have improved little with time. The need to identify optimal management strategies for these clinically complex patients is urgent.
Author Affiliations: Center for Clinical and Genetic Economics (Drs Curtis and Schulman, Ms Greiner, and Mr Hammill), Duke Clinical Research Institute (Drs Kramer, Whellan, and Hernandez), and Department of Medicine (Drs Curtis, Kramer, Whellan, and Hernandez), Duke University School of Medicine, Durham, North Carolina; and Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Whellan).
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