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Shorter Hospital Stays May Hinder Heart Failure Patients
Date:6/1/2010

Quicker discharge tied to more readmissions, at-home deaths, study finds

TUESDAY, June 1 (HealthDay News) -- Americans hospitalized for heart failure are being discharged faster, but the incidence of out-of-hospital deaths and readmissions has increased, a new study finds.

While in-hospital death rates have decreased, "the results are very mixed, and overall you could say that they are worse off," said Dr. Harlan M. Krumholz, professor of medicine at Yale University and a member of a team reporting the finding in the June 2 issue of the Journal of the American Medical Association.

In the study of nearly 7 million Medicare-financed hospitalizations for heart failure, the progressive loss of ability to pump blood, the researchers found that the average length of stay decreased by 2.5 days, from 8.8 days in 1993 to 6.3 days in 2006. The in-hospital death rate was nearly halved, dropping from 8.5 percent to 4.3 percent.

But the overall death rate for the 30-day period starting with hospital admission increased, from 4.3 percent in 1993 to 6.4 percent in 2006, meaning that more deaths occurred after discharge. The net reduction in deaths for the 30 days starting with hospital admission was smaller than for the in-hospital rate, from 12.8 percent in 1993 to 10.7 percent in 2006.

And 20.1 percent of those who left the hospital were readmitted in 2006, compared to 17.1 percent in 1993.

"Patients lost ground when they went home," Krumholz said. "There was no incentive to look at what was happening after discharge. The hospitals kept the patients for the shortest period of time, sent them home and ended up hoping for the best."

It's not clear that there is a direct relationship between a shorter hospital stay and more post-hospital deaths and readmissions, said Dr. Adrian F. Hernandez, an assistant professor of medicine at Duke University, who recently led a study showing that hospitals t
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