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Fewer Medicare patients hospitalized for heart failure died in the 1990s, but shorter hospital stays may be a problem

About half of patients who develop heart failure, mostly elderly patients, will die within 5 years of their diagnosis. Among patients hospitalized for heart failure in Ohio, in-hospital mortality declined substantially between 1991 and 1997. But 30-day mortality declined far less than in-hospital mortality, indicating that mortality shortly after discharge increased, according to a recent study that was supported by the Agency for Healthcare Research and Quality (HS09969). This raises concerns that shorter hospitals stays may be causing adverse consequences for heart failure patients, concludes David W. Baker, M.D., M.P.H., of Case Western Reserve University.

Dr. Baker and his colleagues linked databases from the Cleveland Health Quality Choice (CHQC) program and Medicare to identify first hospital admissions for heart failure and death rate. They used medical chart data from CHQC to analyze trends in mortality adjusted for patient risk of death based on illness severity. At baseline (1991), crude in-hospital, 30-day, and 1-year mortality rates were 6.4 percent, 8.6 percent, and 36.5 percent, respectively. Risk-adjusted in-hospital mortality declined markedly, dropping 3.7 percent, a 52.8 percent relative decrease.

However, 30-day mortality only decreased by 1.4 percent, a 15.3 percent relative decrease, primarily due to a marked rise in the risk of death in the period immediately after discharge.

During the same time, the mean length of hospital stay for heart failure dropped steeply from 9.2 days to 6.6 days (a 33 percent relative decrease). This trend raises concerns that over time, more patients may have been discharged in unstable condition. One-year mortality dropped 5.3 percent, a 14.6 percent relative decrease. Expanded use of angiotensin-converting enzyme inhibitors and more aggressive treatment of hypertension in heart failure patients may have contributed to improvements in 30-day and 1-year survival.

See "Mortality trends for 23,505 Medicare patients hospitalized with heart failure in Northeast Ohio, 1991-1997," by Dr. Baker, Doug Einstadter, M.D., M.P.H., Charles Thomas, M.S., and Randall D. Cebul, M.D., in the American Heart Journal 146, pp. 258-264, 2003.

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