Beta-blocker Use and 30-day All-cause Readmission in Medicare Beneficiaries with Systolic Heart Failure.

Academic Article

Abstract

  • 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.
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    Keywords

  • Beta-blockers, Hospitalization, Older adults, Readmission, Systolic heart failure, Adrenergic beta-Antagonists, Aged, Aged, 80 and over, Cause of Death, Confidence Intervals, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Follow-Up Studies, Heart Failure, Systolic, Hospital Mortality, Humans, Kaplan-Meier Estimate, Male, Medicare, Middle Aged, Patient Discharge, Patient Protection and Affordable Care Act, Patient Readmission, Proportional Hazards Models, Risk Assessment, Survival Analysis, Time Factors, Treatment Outcome, United States
  • Digital Object Identifier (doi)

    Authorlist

  • Bhatia V; Bajaj NS; Sanam K; Hashim T; Morgan CJ; Prabhu SD; Fonarow GC; Deedwania P; Butler J; Carson P
  • Start Page

  • 715
  • End Page

  • 721
  • Volume

  • 128
  • Issue

  • 7