Patients With Heart Failure Readmitted to the Original Hospital Have Better Outcomes Than Those Readmitted Elsewhere

Abstract

Background Up to one fifth of readmissions after a heart failure hospitalization occur at a different hospital. This negatively impacts information continuity, but whether site of readmission impacts subsequent outcomes is unclear. Methods and Results Retrospective cohort study of all patients discharged with a primary diagnosis of heart failure in Canada between April 2004 and December 2013. We compared patients readmitted within 30 days to the original hospital versus a different hospital. Of the 217 039 heart failure patients (mean age, 76.8 years, 50.1% male), 39 368 (18.1%) were readmitted within 30 days—32 771 (83.2%) to the original hospital and 6597 (16.8%) to a different hospital (increasing over time from 15.6% in 2004 to 18.5% by 2013; P for trend=0.001). Patients readmitted to different hospitals were younger and were more likely to be male, have a rural residence, a more‐recent discharge year, an index hospitalization at a teaching hospital, and to be brought in by ambulance at the time of the readmission. Readmissions to the original hospital were substantially shorter (mean, 10.4 days [95% CI , 10.3–10.6] versus 11.6 days [95% CI , 11.3–12.0]; adjusted means, 11.0 versus 12.0; P <0.0001) and had lower mortality (14.4% versus 15.0%; adjusted odds ratio, 0.89; 95% CI , 0.82–0.96) than readmissions to different hospitals. Conclusions 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. Our findings provide further evidence that care fragmentation may be deleterious for patients with heart failure.