Beta-Blocker Use and 30-Day All-Cause Readmission in Medicare Beneficiaries With Systolic Heart Failure

Authors

Vikas Bhatia
Kumar Sanam
Taimoor Hashim
Prakash Deedwania
Wilbert S. Aronow, New York Medical CollegeFollow
Ross Fletcher
Ali AhmedFollow

DOI

10.1016/j.amjmed.2014.11.036

Journal Title

The American Journal of Medicine

First Page

715

Last Page

721

Document Type

Article

Publication Date

7-1-2015

Department

Medicine

Keywords

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

Disciplines

Medicine and Health Sciences

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

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.

Comments

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Recommended Citation

Bhatia, V., Sanam, K., Hashim, T., Deedwania, P., Aronow, W. S., Fletcher, R., & Ahmed, A. (2015). Beta-Blocker Use and 30-Day All-Cause Readmission in Medicare Beneficiaries With Systolic Heart Failure. The American Journal of Medicine, 128 (7), 715-721. https://doi.org/10.1016/j.amjmed.2014.11.036

Publisher's Statement

This is the author's accepted manuscript. The final edited version of this article is available at https://doi.org/10.1016/j.amjmed.2014.11.036

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This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.