MHS

Background—Treatment of chronic heart failure has improved over the past 2 decades, but little is known about whether the improvements are reflected in trends in acute and long-term mortality and hospital readmission. Methods—In a retrospective cohort study of 2 540 838 elderly Medicare beneficiaries hospitalized with heart failure between 2001 and 2005, we examined acute and long-term all-cause mortality and hospital readmission and patient- and hospital-level predictors of those outcomes. Results—Unadjusted in-hospital mortality declined from 5.1 % to 4.2 % during the study period (P <.001), but 30-day, 180-day, and 1-year all-cause mortality remained fairly constant at 11%, 26%, and 37%, respectively. Nearly 1 in 4 patients were readmitted within 30 days of the index hospitalization, and two thirds were readmitted within 1 year. Controlling for patient- and hospital-level covariates, the hazard of all-cause mortality at 1 year was slightly lower in 2005 than in 2001 (hazard ratio, 0.98; 95 % confidence interval, 0.97–0.99). The hazard of readmission did not decline significantly from 2001 to 2005 (HR, 0.99; 95 % CI, 0.98–1.00). Conclusions—Acute and long-term all-cause mortality and hospital readmission remain high and have improved little over time. The need to identify optimal management strategies for these clinically complex patients is urgent