Frequency, trends and institutional variation in 30‐day all‐cause mortality and unplanned readmissions following hospitalisation for heart failure in Australia and New Zealand

Abstract

Aims National 30‐day mortality and readmission rates after heart failure (HF) hospitalisations are a focus of US policy intervention and yet have rarely been assessed in other comparable countries. We examined the frequency, trends and institutional variation in 30‐day mortality and unplanned readmission rates after HF hospitalisations in Australia and New Zealand. Methods and results We included patients >18 years hospitalised with HF at all public and most private hospitals from 2010–15. The primary outcomes were the frequencies of 30‐day mortality and unplanned readmissions, and the institutional risk‐standardised mortality rate (RSMR) and readmission rate (RSRR) evaluated using separate cohorts. The mortality cohort included 153 592 patients (mean age 78.9 ± 11.8 years, 51.5% male) with 16 442 (10.7%) deaths within 30 days. The readmission cohort included 148 704 patients (mean age 78.6 ± 11.9 years, 51.7% male) with 33 158 (22.3%) unplanned readmission within 30 days. In 392 hospitals with at least 25 HF hospitalisations, the median RSMR was 10.7% (range 6.1–17.3%) with 59 hospitals significantly different from the national average. Similarly, in 391 hospitals with at least 25 HF hospitalisations, the median RSRR was 22.3% (range 17.7–27.1%) with 24 hospitals significantly different from the average. From 2010–15, the adjusted 30‐day mortality [odds ratio (OR) 0.991/month, 95% confidence interval (CI) 0.990–0.992, P < 0.01] and unplanned readmission (OR 0.998/month, 95% CI 0.998–0.999, P < 0.01) rates declined. Conclusion Within 30 days of a HF hospitalisation, one in 10 patients died and almost a quarter of those surviving experienced an unplanned readmission. The risk of these outcomes varied widely among hospitals suggesting disparities in HF care quality. Nevertheless, a substantial decline in 30‐day mortality and a modest decline in readmissions occurred over the study period.

Patterns of unplanned readmissions after heart failure hospitalization: novel longitudinal perspectives from Australia and New Zealand

“…However, data regarding trends in 30‐day mortality and unplanned readmission rates following HF hospitalization during this period outside of the US are sparse, but needed to get a better barometer of secular trends in countries where health systems are not penalized by higher readmissions rates. In this issue of the Journal, Labrosciano et al 8 . provide new findings that enrich our understanding of this area.…”

“…Notably, Labrosciano et al 8 . report a substantial decline in unadjusted 30‐day mortality risk (12.5% to 8.1%) but a lesser decline in 30‐day unplanned readmission rate (23.2% to 21.9%) for HF patients.…”

Best of European Journal of Heart Failure at the ESC/HFA Heart Failure Congress 2021

“…The second study providing important insights into HF epidemiology comes from Australia and New Zealand and considered ∼150 000 patients hospitalized for HF in all the public and private hospitals of these countries between 2010 and 2015 4 . Thirty‐day mortality was 10.7% and 30‐day hospitalization rate was 22.3%, with risk standardized rates declining over time, and risk estimates varying among hospitals.…”

March 2021 at a glance: focus on epidemiology, prevention and COVID‐19

“…Changes in the epidemiology and characteristics of cardiogenic shock and acute HF have occurred in the last years. [10][11][12][13] Consistently, a systematic review and meta-regression of 285 studies, representing 15 million acute HF events, found a decline in 30-day mortality [odds ratio (OR) for a 10-year increment, 0.74, 95% confidence interval (CI) 0.61-0.91, P = 0.004] and 1-year mortality (OR 0.86, 95% CI 0.77-0.96, P = 0.007) after acute HF, in the last four decades. However, 30-day and 1-year readmission rates were unchanged.…”