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The State of Heart Failure Care in Canada: Minimal Improvement in Readmissions Over Time Despite an Increased Number
Stephanie Poon1, Benjamin Leis2, Laurie Lambert3
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
Despite advances in heart failure (HF) treatments, Canadian hospitalization and 30-day readmission rates for HF remained unchanged between 2009/2010 and 2018/2019. Length of stay also showed no significant improvement during this period.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Advances in medical and device therapies for heart failure (HF) have occurred over the past decade.
- It remains unclear if these therapeutic advancements have improved patient outcomes in Canada.
Purpose of the Study:
- To evaluate trends in heart failure (HF) hospitalizations and 30-day readmissions in Canada.
- To assess changes in length of stay (LOS) for HF patients over a decade.
Main Methods:
- Utilized the Canadian Institute for Health Information (CIHI) Hospital Morbidity Database for HF admissions (2009/2010 and 2018/2019).
- Analyzed interprovincial variations in patient demographics, LOS, discharge disposition, and hospital type.
- Calculated national and provincial rates of HF admissions and all-cause 30-day readmissions.
Main Results:
- Adjusted HF admission rates were stable at 216 per 100,000 population.
- The national 30-day all-cause readmission rate remained constant at 20.6%.
- Median HF length of stay (LOS) was unchanged at 7 days.
Conclusions:
- National heart failure (HF) admission rates, 30-day readmissions, and LOS have not changed significantly from 2009/2010 to 2018/2019.
- This stability persisted despite concurrent advancements in medical and device therapies for HF.
Background:
An unanswered question is whether the combination of advances in medical and device therapy over the past decade has translated into improved outcomes for patients with heart failure (HF) in Canada.
Methods:
The Canadian Institute for Health Information (CIHI) Hospital Morbidity Database was used to identify hospitalizations for HF among patients aged 18 years and older in Canadian hospitals during fiscal years 2009/2010 and 2018/2019. We assessed interprovincial differences in age, sex, length of stay (LOS), discharge disposition, type of admitting hospital, and most responsible service, for all HF admissions. National and provincial rates of HF admissions and all-cause 30-day readmissions were calculated.
Results:
After adjusting for age, the rate of HF admissions in Canada was 216 per 100,000 population in 2009/2010 and 2018/2019. The majority of patients with HF were admitted to general internal medicine and community hospitals in both 2009/2010 and 2018/2019. The national, crude, all-cause 30-day readmission rate stayed constant at 20.6%, and the majority of patients were readmitted with the diagnosis of HF in both 2009/2010 (62.5%) and 2018/2019 (59.0%). Median and interquartile range of HF LOS also remained unchanged at 7 days (3-14).
Conclusions:
The national rate of HF admissions, 30-day readmissions, and HF LOS have remained unchanged from 2009/2010 to 2018/2019, despite advances in medical and device therapy during this timeframe.
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