Readmissions and the quality of care in patients hospitalized with heart failure

Objectives. Clinical practice guidelines based on the results of randomized clinical trials recommend that patients with heart failure due to left ventricular systolic dysfunction (LVSD) be treated with angiotensin-converting enzyme inhibitors (ACEI) at doses shown to reduce mortality and readmissio...

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Bibliographic Details
Published in:International journal for quality in health care 2003-10, Vol.15 (5), p.413-421
Main Authors: Luthi, Jean-Christophe, Lund, Mary Jo, Sampietro-Colom, Laura, Kleinbaum, David G., Ballard, David J., McClellan, William M.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
angiotensin-converting enzyme inhibitors
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Cohort Studies
Comorbidity
Female
Guideline Adherence
heart failure
Heart Failure - drug therapy
Heart Failure - etiology
Hospitals, Community - statistics & numerical data
Humans
left ventricular systolic dysfunction
Length of Stay - statistics & numerical data
Male
Medicare
Middle Aged
Outcome and Process Assessment (Health Care) - statistics & numerical data
outcome assessment
Patient Discharge - statistics & numerical data
Patient Readmission - statistics & numerical data
Quality Indicators, Health Care - statistics & numerical data
quality of health care
readmissions
Smoking
United States
Ventricular Dysfunction, Left - complications
Ventricular Dysfunction, Left - drug therapy
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Summary:Objectives. Clinical practice guidelines based on the results of randomized clinical trials recommend that patients with heart failure due to left ventricular systolic dysfunction (LVSD) be treated with angiotensin-converting enzyme inhibitors (ACEI) at doses shown to reduce mortality and readmission. This study examined the relationship between ACEI use at discharge and readmission among patients with heart failure due to LVSD. Methods and results. Data were abstracted from the medical records of 2943 randomly selected patients hospitalized for heart failure in 50 hospitals. The outcome of interest was the number of readmissions occurring up to 21 months after discharge. Six-hundred and eleven patients were eligible for analysis. Compared with patients discharged at a recommended ACEI dose, patients not prescribed an ACEI at discharge had an adjusted rate ratio of readmission (RR) of 1.74 [95% confidence interval (CI) 1.22–2.48], while patients prescribed an ACEI at less than a recommended dose had an RR of 1.24 (95% CI 0.91–1.69) (P = 0.005 for the trend). Conclusion. Our results show that ACEI use at discharge in patients with LVSD is associated with decreased rate of readmission. These findings suggest that compliance with the ACEI prescribing recommendations listed in clinical practice guidelines for patients with heart failure due to LVSD confers benefit.
ISSN:1353-4505
1464-3677
DOI:10.1093/intqhc/mzg055