Heart failure

High rates of HF mortality and readmissions suggest need for policy intervention


Heart failure continues to be associated with high rates of early mortality and hospital readmissions in Australia despite some improvement seen recent years, a study shows.

One in ten patients hospitalised with heart failure died within 30 days and almost a quarter of those surviving experienced an unplanned readmission, according to national figures for the period 2010-2015.

The study, which covered more than 154,000 heart failure admissions at more than 390 public and private hospitals in Australia and New Zealand, also revealed wide variations in outcomes among hospitals, suggesting disparities in heart failure care quality.

Published in the European Journal of Heart Failure, the study showed there has been a decline in 30-day mortality for hospitalised HF patients of 0.84% a year, from 12.5% in 2010 to 8.1% in 2015, and a more modest decline in 30-day unplanned readmission rate of 0.24% a year, from 23.2% to 21.9%.

Led by researchers from Adelaide University, the study found that over the 2010-2015 period the median risk‐standardised 30-day mortality rate was 10.7% (range 6.1%-17.3%) and the 30-day readmission rate was 22.3% (range 17.7%-27.1%).

However the mortality and unplanned readmission rates varied two to three-fold among hospitals, with about 15% hospitals having rates significantly different to the national average.

The study authors said the Australian rates were higher than those reported in the US, where previously high rates of heart failure deaths and unplanned readmissions – as well as variability in HF outcomes among hospitals – had led to the introduction of policies to improve quality of HF care.

These policies, such as reporting of institutional outcome rates and financial penalties for hospitals with high readmission rates, have been credited with a decline in 30-day readmission rates from 21.5% to 17.8% since 2012.

“The divergent trends in readmissions that we observed when compared with the US suggests policy reforms such as the Hospital Readmissions Reduction Program (HRRP) are likely to be effective at reducing readmissions,” the authors wrote.

However they acknowledged that Australia was already experiencing a decline in HF mortality despite the absence of such policies targeted at improving HF care.

The improvement in HF mortality might be due to advances in risk factor management, improved disease detection, and better in-hospital care and secondary prevention, they suggested.

“In our study, in-hospital deaths declined more than postdischarge deaths. This may indicate the need for greater emphasis on patient enrolment in community HF management programs that have been shown to reduce all-cause mortality and rehospitalisations,” they said.

“Access to such programs remains suboptimal with recent findings suggesting differences in access may explain differences in readmission rates among Australian hospitals.”

“Fewer in-hospital deaths may also build a reservoir of surviving patients at higher risk of readmission and may explain the limited reduction in readmission rate over time,” they added.

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