Is 30-Day Mortality a Better Predictor of HF Survival Than Hospital Readmission Rate?
A recent study investigated whether risk-standardized mortality rate (RSMR) is an effective predictor of long-term survival in hospitalized patients with heart failure.
For patients who are hospitalized with heart failure, the long-term impact of hospitalization based on 30-day RSMRs is relatively unknown.
Gregg C Fonarow, MD, Ahmanson-UCLA Cardiomyopathy Center (Los Angeles, CA), and associated editor, Health Care Quality and Guidelines, JAMA Cardiology, and colleagues conducted a longitudinal observational study to evaluate the association of hospital-specific 30-day RSMR with long-term survival among 106,304 patients hospitalized with heart failure in the American Heart Association Get With the Guidelines-Heart Failure registry. Participants were admitted to 317 centers from 2005 through 2013 and had Medicare-linked follow-up data.
Hospital-specific 30-day RSMR was calculated using a hierarchical logistic regression model, which had 30-day mortality rate as a binary outcome, patient baseline characteristics as covariates, and hospitals as random effects. The association between 30-day RSMR-based hospital groups and long-term mortality was evaluated using adjusted Cox models.
Long-term mortality was measured through one-year, 3-year, and 5-year mortality rates. The 30-day RSMR-based hospital groups were designated by low (quartile 1 [Q1]) to high (Q4) 30-day RSMR.
The study was published in JAMA Cardiology (online March 12, 2018; doi:10.1001/jamacardio.2018.0579).
Results of the study showed the median 30-day RSMR was 9.7% overall – 8.64% for Q1 based on RSMR and 10.75% for Q4. Researchers noted that Q1 hospitals were more likely to be large, based in urban areas, and offer more advanced heart failure treatments.
Additionally, researchers reported that survival at one-year, 3-years, and 5-years was superior for patients treated at the Q1 hospitals compared with patients at the Q4 hospitals. Five-year mortality was 73.1% for Q1 compared with 76.8% for Q4, with an adjusted relative hazard of mortality of 1.14 for high versus low RSMR hospitals.
Dr Fonarow and colleagues acknowledged that these differences in 30-day survival continued to accrue beyond 30 days and persisted long term. The concluded that “30-day RSMR may be a useful heart failure performance metric to incentivize quality care and improve long-term outcomes.”—Zachary Bessette