After Hospital Discharge, Risks Still High

Heart attack and heart failure patients face high risk of death or return to the hospital

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Many heart attack and heart failure patients think they’re out of the woods after they’ve left the hospital for a month or more. But readmission rates are still high.

Standard practice by Medicare is to track deaths and readmissions of heart attack and heart failure patients for only 30 days after discharge.

According to new research, heart attack and heart failure patients have a high risk of death or readmission for a month or longer after leaving the hospital.

The current system, however, misses those longer periods of increased risk when people may need special care.

"If you feel ill, contact your physician."

Kumar Dharmarajan, MD, lead author of the study and a fellow in cardiology at Columbia University Medical Center in New York City, and visiting scholar at Yale University in New Haven, Connecticut, collaborated with fellow researchers examining Medicare data on 878,963 patients discharged from the hospital for heart failure and 350,509 discharged for heart attack.

Within the first year, seven out of ten patients with heart failure were rehospitalized, and half of the heart attack patients returned to a hospital.

About two out of five heart failure patients died and a quarter of the heart attack patients did not survive within the first year.

“The risks of death and rehospitalization can extend well beyond 30 days after discharge, the time period used by the federal government for measuring hospital performance,” said Dr. Dharmarajan.

For example, the risk of rehospitalization after heart failure took 43 days to decline 50 percent from its peak level after discharge.

The authors concluded that “this extended period of risk for readmission may justify continued vigilance beyond the 30-day period used by Medicare to evaluate hospital readmission performance.”

John A. Dieck, MD, President, Texas Heart & Vascular PLLC and dailyRx Contributing Expert said, "This statistically powerful study underlines the importance of outpatient follow up for patients with heart failure and heart attack.  Hospitals now methodically give patients educational material upon discharge.  Patients need to read these, become familiar with them, and clarify any questions before discharge.  For example, patients with congestive heart failure can frequently prevent hospital readmission if they contact their doctors immediately upon noticing undue weight gain, ankle swelling, or sleeping less well flat on their backs."

After hospitalization for heart failure and heart attack, risk of death is highest on day 1 after discharge and then declines rapidly. In contrast, risk of readmission peaks later and declines more slowly.

“In the weeks after hospital discharge, your risk of death, rehospitalization and other complications is very high,” said Dr. Dharmarajan.

“If you feel ill, take it seriously and contact your healthcare provider.”

The study was presented May 16 at the American Heart Association’s Quality of Care and Outcomes Scientific Sessions 2013.

Reviewed by: 
Review Date: 
May 16, 2013
Last Updated:
August 13, 2013