Author + information
- Received September 22, 2019
- Revision received December 6, 2019
- Accepted December 9, 2019
- Published online February 17, 2020.
- Dennis T. Ko, MD, MSca,b,c,∗ (, )@denniskomd,
- Rohan Khera, MD, MSCSd,
- Geoffrey Lau, BScb,
- Feng Qiu, MScb,
- Yongfei Wang, MSe,f,
- Peter C. Austin, PhDb,
- Maria Koh, MScb,
- Zhenqiu Lin, PhDf,
- Douglas S. Lee, MD, PhDb,c,g,
- Harindra C. Wijeysundera, MD, PhDa,b,c and
- Harlan M. Krumholz, MD, SMe,f,h
- aSchulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- bICES, Toronto, Ontario, Canada
- cInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- dUniversity of Texas Southwestern Medical Center, Dallas, Texas
- eSection of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- fCenter for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- gUniversity Health Network, Toronto, Ontario, Canada
- hDepartment of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
- ↵∗Address for correspondence:
Dr. Dennis T. Ko, ICES G1- 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
Background Readmission rates after acute myocardial infarction (AMI) and heart failure (HF) hospitalizations have decreased in the United States since the implementation of the Hospital Readmissions Reduction Program.
Objectives This study was designed to examine the temporal trends of readmission and mortality after AMI and HF in Ontario, Canada, where reducing hospital readmissions has not had a policy incentive.
Methods The cohort was comprised of AMI or HF patients 65 years of age or older who had been hospitalized from 2006 to 2017. Primary outcomes were 30-day readmission and post-discharge mortality. Secondary outcomes included in-hospital mortality, 30-day mortality from admission, and in-hospital mortality or 30-day mortality post-discharge. Adjusted monthly trends for each outcome were examined over the study period.
Results Our cohorts included 152,808 AMI and 223,283 HF patients. Age- and sex-standardized AMI hospitalization rates in Ontario declined 32% from 2006 to 2017 while HF hospitalization rates declined slightly (9.1%). For AMI, risk-adjusted 30-day readmission rates declined from 17.4% in 2006 to 14.7% in 2017. All AMI risk-adjusted mortality rates also declined from 2006 to 2017 with 30-day post-discharge mortality from 5.1% to 4.4%. For HF, overall risk-adjusted 30-day readmission was largely unchanged from 2006 to 2014 at 21.9%, followed by a decline to 20.8% in 2017. Risk-adjusted 30-day post-discharge mortality declined from 7.1% in 2006 to 6.6% in 2017.
Conclusions The patterns of outcomes in Ontario are consistent with the United States for AMI, but diverge for HF. For AMI and HF, admissions, readmissions, and mortality rates declined over this period. The reasons for the country-specific patterns for HF need further exploration.
Analysis of this study was funded by a Foundation Grant (FDN-154333) from the Canadian Institutes of Health Research. Drs. Ko, Austin, and Lee are supported by a Clinician Scientist Award from the Heart and Stroke Foundation of Canada. Dr. Lee is supported by the Ted Rogers Chair in Heart Function Outcomes. Dr. Wijeysundera is supported by a Distinguished Clinician Scientist Award from the Heart and Stroke Foundation of Canada. Dr. Krumholz works under contract with the Centers for Medicare & Medicaid Services to support quality measurement programs; was a recipient of a research grant, through Yale, from Medtronic and the U.S. Food and Drug Administration to develop methods for post-market surveillance of medical devices; was a recipient of a research grant with Medtronic; is the recipient of a research grant from Johnson & Johnson, through Yale University, to support clinical trial data sharing; was a recipient of a research agreement, through Yale University, from the Shenzhen Center for Health Information for work to advance intelligent disease prevention and health promotion; collaborates with the National Center for Cardiovascular Diseases in Beijing; receives payment from the Arnold & Porter Law Firm for work related to the Sanofi clopidogrel litigation; receives payment from the Ben C. Martin Law Firm for work related to the Cook Celect IVC filter litigation; receives payment from the Siegfried and Jensen Law Firm for work related to Vioxx litigation; chairs a Cardiac Scientific Advisory Board for UnitedHealth; was a participant/participant representative of the IBM Watson Health Life Sciences Board; is a member of the Advisory Board for Element Science and Facebook; is a member of the Physician Advisory Board for Aetna; is the co-founder of HugoHealth, a personal health information platform; and is co-founder of Refactor Health, an enterprise healthcare AI-augmented data management company. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 22, 2019.
- Revision received December 6, 2019.
- Accepted December 9, 2019.
- 2020 American College of Cardiology Foundation
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