Open AccessMortality and Readmission Rates in Patients Hospitalized for Acute Decompensated Heart Failure: A Comparison Between Cardiology and General‐Medicine Service Outcomes in an Underserved Population
Author(s) -
Selim Ahmed M.,
Mazurek Jeremy A.,
Iqbal Muhammad,
Wang Dan,
Negassa Abdissa,
Zolty Ronald
Publication year - 2015
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22372
Subject(s) - medicine , acute decompensated heart failure , hazard ratio , confidence interval , heart failure , hospital medicine , emergency medicine , retrospective cohort study , mortality rate , cohort , population , cardiology , environmental health
Background With recent legislation imposing penalties on hospitals for above‐average 30‐day all‐cause readmissions for patients with acute decompensated heart failure ( ADHF ), there is concern these penalties will more heavily impact hospitals serving socioeconomically vulnerable and underserved populations. Hypothesis Patients with ADHF and low socioeconomic status have better postdischarge mortality and readmission outcomes when cardiologists are involved in their in‐hospital care. Methods We retrospectively searched the electronic medical record for patients hospitalized for ADHF from 2001 to 2010 in 3 urban hospitals within a large university‐based health system. These patients were divided into 2 groups based on whether a cardiologist was involved in their care or not. Measured outcomes were 30‐ and 60‐day postdischarge mortality and readmission rates. Results Out of the 7516 ADHF patients, 1434 patients were seen by a cardiologist (19%). These patients had lower 60‐day mortality (5.4% vs 7.0%; hazard ratio [ HR ]: 0.70, 95% confidence interval [ CI ]: 0.52‐0.96, P = 0.034) and lower 30‐ and 60‐day readmission rates (16.7% vs 20.6%; HR : 0.76, 95% CI : 0.66‐0.89, P = 0.002, and 26.1% vs 30.2%; HR : 0.81, 95% CI : 0.72‐0.92, P = 0.003, respectively). There was no significant difference in the in‐hospital mortality between the 2 groups. Compared with other races, whites with systolic HF have marginally lower HF ‐related readmission rates when treated by cardiologists. Conclusions In this cohort of ADHF patients from the Bronx, New York, involvement of a cardiologist resulted in improved short‐term mortality and readmission outcomes compared with treatment by general internal medicine.