Risk remains high beyond 30 days of discharge for MI, heart failure

Risk of rehospitalization or death is slow to decline for older patients after hospital discharge from heart failure, acute MI or pneumonia, according to a study published in the Feb. 6 issue of BMJ.

The study captured changing rates for death or rehospitalization through one year for over 3 million Medicare fee-for-service beneficiaries hospitalized and discharged alive between 2008 and 2010. Kumar Dharmarajan, MD, MBA, of the Yale University School of Medicine in New Haven, Conn., and colleagues found that while patient risk did improve over time, within one year, 67.4 percent, 49.9 percent and 55.6 percent of heart failure, acute MI and pneumonia patients, respectively, had been readmitted while 35.8 percent, 25.1 percent and 31.1 percent, respectively, had died.

Risk was dependent on discharge diagnosis and both death or hospital readmission remained high for months. However, risk for rehospitalization remained elevated for a longer period, particularly for heart failure or pneumonia. After 11, 10, and six days, risk of death for patients with heart failure, pneumonia or acute MI, respectively, had decreased by 50 percent. After 21, 21 and 19 days, risk of death had declined by 95 percent, respectively.

Readmission risk declined by 50 percent for patients with heart failure around 38 days. For patients with pneumonia, it took 25 days to reduce readmission risk by 50 percent and for patients with acute MI, 13 days. Risk for readmission declined by 95 percent at 45, 45, and 38 days for patients with heart failure, pneumonia or acute MI, respectively.

“If we can track absolute risks and their changes over time, this information will be critical in helping patients and hospitals set realistic expectations and goals for recovery, and plan for appropriate care after discharge,” Dharmajaran said in a press release.

The research team suggested extra vigilance in patient condition in the first seven weeks of patient recovery. Although risks are high preceeding it, the findings appear to highlight a shift to a different period in patient recovery at that point.