Beta-blocker Use and 30-day All-cause Readmission in Medicare Beneficiaries with Systolic Heart Failure - 17/06/15
, Navkaranbir S. Bajaj, MD a, b, Kumar Sanam, MD a, Taimoor Hashim, MD a, Charity J. Morgan, PhD a, Sumanth D. Prabhu, MD a, b, Gregg C. Fonarow, MD c, Prakash Deedwania, MD d, Javed Butler, MD, MPH e, Peter Carson, MD f, Thomas E. Love, PhD g, Raya Kheirbek, MD f, Wilbert S. Aronow, MD h, Stefan D. Anker, MD, PhD i, Finn Waagstein, MD, PhD j, Ross Fletcher, MD f, Richard M. Allman, MD k, Ali Ahmed, MD, MPH fAbstract |
Background |
Beta-blockers improve outcomes in patients with systolic heart failure. However, it is unknown whether their initial negative inotropic effect may increase 30-day all-cause readmission, a target outcome for Medicare cost reduction and financial penalty for hospitals under the Affordable Care Act.
Methods |
Of the 3067 Medicare beneficiaries discharged alive from 106 Alabama hospitals (1998-2001) with a primary discharge diagnosis of heart failure and ejection fraction <45%, 2202 were not previously on beta-blocker therapy, of which 383 received new discharge prescriptions for beta-blockers. Propensity scores for beta-blocker use, estimated for each of the 2202 patients, were used to assemble a matched cohort of 380 pairs of patients receiving and not receiving beta-blockers who were balanced on 36 baseline characteristics (mean age 73 years, mean ejection fraction 27%, 45% women, 33% African American).
Results |
Beta-blocker use was not associated with 30-day all-cause readmission (hazard ratio [HR] 0.87; 95% confidence interval [CI], 0.64-1.18) or heart failure readmission (HR 0.95; 95% CI, 0.57-1.58), but was significantly associated with lower 30-day all-cause mortality (HR 0.29; 95% CI, 0.12-0.73). During 4-year postdischarge, those in the beta-blocker group had lower mortality (HR 0.81; 95% CI, 0.67-0.98) and combined outcome of all-cause mortality or all-cause readmission (HR 0.87; 95% CI, 0.74-0.97), but not with all-cause readmission (HR 0.89; 95% CI, 0.76-1.04).
Conclusions |
Among hospitalized older patients with systolic heart failure, discharge prescription of beta-blockers was associated with lower 30-day all-cause mortality and 4-year combined death or readmission outcomes without higher 30-day readmission.
Le texte complet de cet article est disponible en PDF.Keywords : Beta-blockers, Hospitalization, Older adults, Readmission, Systolic heart failure
Plan
| Funding: AA was in part supported by NIH grants (R01-HL085561 and R01-HL097047) from the NHLBI, Bethesda, Maryland and an intramural support from the UAB Comprehensive Cardiovascular Center. |
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| Conflicts of Interest: None. |
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| Authorship: All authors had access to the data and a role in writing the manuscript. |
Vol 128 - N° 7
P. 715-721 - juillet 2015 Retour au numéro
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