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Return to Same Hospital Lowers Mortality, LOS for Heart Failure Patients

EDMONTON, CANADA — When discharged patients boomerang back to your hospital, it might not look very good in terms of quality statistics, but it can be beneficial to them, a new study suggests.

A report in the Journal of the American Heart Association notes that when heart failure patients were readmitted within a month, those returning to the same facility not only were discharged quicker, but their mortality rates were lower.

The study team, led by University of Alberta researchers, pointed out that the optimal situation can be difficult to achieve because, in both Canada and the United States, ambulance policies often require that patients be transported to the nearest ED, even if they had been hospitalized elsewhere recently.

"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," explained lead author Finlay A. McAlister, MD, MSc, professor of general internal medicine at the University of Alberta.

The study used data on readmissions for all patients discharged with a primary diagnosis of heart failure in Canada between 2004 and 2013, with about 217,000 patients averaging 76.8 years old. Of those, 18.1% were readmitted within the month after discharge, with 83.2% returning to the original hospital and 16.8% transported elsewhere. Heart failure was the cause of readmission for 36.9%.


Results indicate that heart failure patients who were readmitted to the same hospital were discharged an average of one day earlier and also had an 11% lower mortality rate.

"For the individual patient, these differences may not seem like much, but considering that heart failure is one of the most common reasons for hospitalization (and readmission) in North America, it's a big issue for the healthcare system," McAlister pointed out.

"Readmissions to a different hospital are becoming more frequent over time and are associated with longer stays and higher mortality rates than readmissions to the original hospital,” the study authors concluded. “Our findings provide further evidence that care fragmentation may be deleterious for patients with heart failure."