A new study finds that for patients who need to be readmitted to Canadian hospitals for heart failure, where they end up matters, as those readmitted to a different hospital tend to have longer hospital stays and higher mortality rates.
Heart failure occurs when the heart’s ability to pump blood has been compromised, for instance, as a result of coronary artery disease or high blood pressure. It can produce a range of symptoms from fatigue and shortness of breath to kidney and liver damage, arrhythmia and heart valve problems, and in Canada, the condition is on the rise.
About 600,000 Canadians currently live with heart failure, according to the Heart and Stroke Foundation, with 50,000 new cases diagnosed every year. In part, the rise stems from our being victims of our own success, as improvements in medical treatment for heart condition have led to higher survival rates for heart attacks and people being able to live longer with damaged hearts.
But heart failure also produces high rates of hospitalization and, importantly, readmission. Most patients get readmitted to the same hospital to which they were first admitted, as continuity of care and of information are known to be important considerations. “Every time a patient is admitted to a new hospital, it’s like starting from square one,” says Dr. Finlay McAlister of the University of Alberta and the Mazankowski Alberta Heart Institute in Edmonton and lead author of a new study on hospital readmissions, to Medscape.
But Dr. McAlister says that increasingly because of issues like hospital crowding and cost reductions, ambulances are taking patients to the nearby hospital with the shortest wait time, rather than ensuring that patients end up at hospitals where they had been previously seen or ones at which their physician admits patients.
Indeed, a 2010 study in the United States found that between 1993 and 2006, length of hospital stays decreased from 8.8 days to 6.3 days while 30-day readmission rates rose from 17.2 per cent to 20.1 per cent.
To get more perspective on the trend in Canada, Dr. McAlister and colleagues looked at medical records for 217,039 patients discharged from Canadian hospitals between April 2004 and December 2013 with a primary diagnosis of heart failure. Of that group, they found 39,368 (18.1 per cent) were readmitted within 30 days, with 83.2 per cent of that group being readmitted to their original hospital and 16.8 per cent (a little under one fifth) to a different one, representing a 2.9 per cent increase in other-hospital readmission between 2004 and 2013.
In terms of outcomes, those readmitted to a different hospital had an average hospital stay the second time around of 11.6 days versus only 10.4 for those who were readmitted to their original hospital. In-hospital mortality rates varied, too, with the different-hospital group having a 15.0 per cent mortality rate in comparison to 14.4 per cent for the same-hospital group.
The researchers see their results as speaking to the need to reconsider health care policy around ambulance services and putting less focus on shortening wait times in emergency rooms. “Given the poorer prognosis associated with alternate hospital readmission, our data suggest that clinicians should counsel patients on the potential benefits of returning to their original hospital if they deteriorate,” say the study’s authors.
The research is published in the Journal of the American Heart Association.