Heart failure patients readmitted to the same hospital may have better outcomes

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When patients with heart failure were re-hospitalised within a month, those who returned to the same hospital were discharged quicker and were more likely to survive, according to new Canadian research in the Journal of the American Heart Association.

In both Canada and the USA, ambulance policies usually require patients be taken to the nearest emergency room, even if a patient has recently been hospitalised somewhere else.

“This makes sense in time-sensitive acute conditions where delays in initial treatment are associated with poorer outcomes—thus the adage “time is muscle” for heart attacks and “time is brain” for strokes. Heart failure is a chronic condition and continuity of care seems to be more important,” said Finlay A McAlister, study lead author and professor of general internal medicine at the University of Alberta in Edmonton, Canada.

Researchers examined data on readmissions for all patients discharged with a primary diagnosis of heart failure in Canada between 2004 and 2013. Of the 217,039 patients (average age 76.8 years, 50.1% male), 18.1% were readmitted within 30 days—83.2% to the original hospital and 16.8% to a different hospital. The most common cause for readmission was heart failure (36.9%).

After adjusting for factors such as age and gender, heart failure patients who were readmitted to the same hospital were discharged an average of one day sooner and were 11% less likely to die during their hospitalisation.

“For the individual patient, these differences may not seem like much, but considering that heart failure is one of the most common reasons for hospitalisation (and readmission) in North America, it is a big issue for the healthcare system,” McAlister says.

Although Canada has free universal access to hospital care, the findings in this study are likely to apply to the USA as well, since there are similar rates of readmission for heart failure and similar gaps in the transfer of medical information from one facility to another, researchers said.

“Patients’ hospital records may not be completed for weeks and they do not report all of the things that happened during the initial hospitalisation. For example, it is not uncommon for heart failure patients to not tolerate or have adverse responses to higher doses of some guideline-recommended medications. That information rarely appears on discharge summaries, so patients are at risk of the same thing happening if they are admitted to a different hospital,” McAlister says.

“If you are discharged from the hospital after heart failure, book a follow-up appointment with your physician within two weeks of discharge. If your condition deteriorates, try to see a familiar physician as soon as possible,” McAlister says.

In the study, patients readmitted to a different hospital were younger and more likely to be male, live in a rural area and to have arrived at the new hospital by ambulance.

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