Outcomes in acute heart failure: 30-day readmission versus death

For patients hospitalized with acute heart failure, health policy initiatives in the USA have drawn attention to 30-day mortality and readmission. Confusion around definitions, populations, and thus reported rates for these two outcomes is common. Among Medicare fee-for-service patients hospitalized with heart failure, all-cause mortality 30 days from the time of admission is 11.7 % and all-cause unplanned readmission 30 days from discharge is 23.0 %. Rates for Medicaid and commercially insured patients are lower. Mortality rates have been relatively stable, while readmission rates increased under the Diagnosis Related Group payment system then began decreasing under the Hospital Readmission Reductions Program. Risk models are reasonable at predicting mortality, whereas readmission has been harder to anticipate. The use of risk-standardized hospital rates as performance measures has generated considerable debate. Future work should clarify the interaction between the two measures, the optimal time window and factors influencing rates and trends-including socioeconomic status.