Heart Failure Readmission After Mitral Valve Repair and Replacement: Five-Year Follow-Up in the Medicare Population

被引:22
作者
Vassileva, Christina M.
Ghazanfari, Naseem
Spertus, John
McNeely, Christian
Markwell, Stephen
Hazelrigg, Stephen
机构
[1] So Illinois Univ, Sch Med, Div Cardiothorac Surg, Dept Surg, Springfield, IL 62794 USA
[2] Univ Missouri, St Lukes Mid Amer Heart Inst, Kansas City, MO 64110 USA
关键词
SURGICAL-CORRECTION; ECONOMIC BURDEN; REGURGITATION; SURVIVAL;
D O I
10.1016/j.athoracsur.2014.07.040
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Readmission rates are well established as a quality indicator for heart failure (HF). We analyzed HF readmission rates after mitral valve repair (MVP) and replacement (MVR). Methods. We included 21,138 Medicare beneficiaries with primary isolated MVP (n = 6,896) or MVR (n = 14,242) from 2000 through 2004. Readmission rates were identified using MedPar records subsequent to the index procedure during a 5-year follow-up. Treating death as a competing risk, cumulative readmission incidences were analyzed and stratified by presence or absence of preoperative HF. Results. Preoperative HF was present in 61.0% of the patients. All-cause readmission rates were 24.9% at 30 days and 78.0% at 5 years. The cumulative incidence of readmission for HF remained almost 3 times higher in patients with preoperative HF compared with those without for MVP (2.1% vs 5.9% in 30 days and 10.3% vs 26.3% in 5 years) and 2 times higher for MVR (3.6% vs 7.4% in 30 days and 15.8% vs 30.4% in 5 years). Regardless of procedure type, patients without preoperative HF had significantly lower HF readmission rates (3.0% vs 7.0% in the first 30 days and 13.6% vs 29.2% after 5 years) (p = 0.0001). Conclusions. Hospital readmission after mitral surgery is high. Preoperative heart failure is associated with higher postoperative readmission rates. Because admission for heart failure accounts for a significant proportion of these readmissions, close follow-up of patients with known mitral valve disease and referral to surgery prior to development of heart failure may decrease postoperative readmission rates. (C) 2014 by The Society of Thoracic Surgeons
引用
收藏
页码:1544 / 1550
页数:7
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