Relation between process measures and diagnosis-specific readmission rates in patients with heart failure

Objectives: To explore the relations between cause-specific readmission rates and National Heart Failure Audit process of care measures in patients admitted for heart failure (HF). Methods: Using admissions data for all acute hospitals in England for April 2009-March 2012, we defined an index admission as the first emergency admission with a primary diagnosis of HF for at least three years. We compared risk-adjusted readmission rates for HF and for all non-HF diagnoses combined, risk-adjusted in-hospital mortality rates and performance on six Audit process measures. Results: 14.7% of 123 644 patients died during the index admission. Of 105 441 index live discharges, 6853 (6.5%) were readmitted as emergencies within 7 days and 20 144 (19.1%) within 30 days. Index admission mortality rates correlated positively but weakly with non- HF readmission rates but not at all with HF rates. There was modest positive correlation at 7 days between HF and non-HF readmission rates (r=+0.24) but no significant relation at 30 or 365 days. All six process measures ( prescribing of ACE inhibitors and beta-blockers, echocardiogram, cardiology inpatient and follow-up by cardiologist and HF liaison) correlated modestly but significantly with lower HF readmission rates at 7 days (r at most -0.26), only three did at 30 days and only cardiology follow-up did for non-HF at either 7 or 30 days; all associations were diminished at 365 days. Conclusions: Hospitals scoring higher on evidence-based HF process measures had lower readmission rates, though the association seems limited to HF readmissions and is modest in strength and duration.