Patterns of Hospital Performance in Acute Myocardial Infarction and Heart Failure 30-Day Mortality and Readmission

TLDR

The Centers for Medicare & Medicaid Services began publicly reporting hospital‑level risk‑standardized 30‑day mortality and readmission rates for acute myocardial infarction and heart failure in 2009. This study maps patterns of hospital performance using those publicly reported measures. We calculated and compared weighted risk‑standardized 30‑day mortality and readmission rates for Medicare fee‑for‑service beneficiaries aged 65+ with primary AMI or HF discharged between July 2005 and June 2008 across Hospital Referral Regions and hospital structural characteristics. Median 30‑day mortality was 16.6% for AMI and 11.1% for HF, while readmission rates were 19.9% for AMI and 24.4% for HF, with substantial geographic variation and high‑ and low‑performing hospitals across all types, indicating that readmission rates were particularly high.

Abstract

Background— In 2009, the Centers for Medicare & Medicaid Services is publicly reporting hospital-level risk-standardized 30-day mortality and readmission rates after acute myocardial infarction (AMI) and heart failure (HF). We provide patterns of hospital performance, based on these measures. Methods and Results— We calculated the 30-day mortality and readmission rates for all Medicare fee-for-service beneficiaries ages 65 years or older with a primary diagnosis of AMI or HF, discharged between July 2005 and June 2008. We compared weighted risk-standardized mortality and readmission rates across Hospital Referral Regions and hospital structural characteristics. The median 30-day mortality rate was 16.6% for AMI (range, 10.9% to 24.9%; 25th to 75th percentile, 15.8% to 17.4%; 10th to 90th percentile, 14.7% to 18.4%) and 11.1% for HF (range, 6.6% to 19.8%; 25th to 75th percentile, 10.3% to 12.0%; 10th to 90th percentile, 9.4% to 13.1%). The median 30-day readmission rate was 19.9% for AMI (range, 15.3% to 29.4%; 25th to 75th percentile, 19.5% to 20.4%; 10th to 90th percentile, 18.8% to 21.1%) and 24.4% for HF (range, 15.9% to 34.4%; 25th to 75th percentile, 23.4% to 25.6%; 10th to 90th percentile, 22.3% to 27.0%). We observed geographic differences in performance across the country. Although there were some differences in average performance by hospital characteristics, there were high and low hospital performers among all types of hospitals. Conclusions— In a recent 3-year period, 30-day risk-standardized mortality rates for AMI and HF varied among hospitals and across the country. The readmission rates were particularly high.