Trajectories of Risk for Specific Readmission Diagnoses after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia

• Published in: PloS one Vol. 11; no. 10; p. e0160492
• Main Authors: Krumholz, Harlan M., Hsieh, Angela, Dreyer, Rachel P., Welsh, John, Desai, Nihar R., Dharmarajan, Kumar
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.10.2016; Public Library of Science (PLoS)
• Subjects: Aged; Aged, 80 and over; Anemia; Bleeding; Comparative analysis; Diagnostic systems; Fee-for-Service Plans - statistics & numerical data; Female; Geriatrics; Government programs; Health care; Health risks; Heart; Heart attack; Heart attacks; Heart diseases; Heart failure; Heart Failure - diagnosis; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Humans; Internal medicine; Legal fees; Male; Medicaid; Medical diagnosis; Medicare; Medicare - statistics & numerical data; Medicine; Medicine and Health Sciences; Mortality; Myocardial infarction; Myocardial Infarction - diagnosis; Older people; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Pneumonia; Pneumonia - diagnosis; Population; Recovery; Risk; Risk factors; Social Sciences; Studies; Time Factors; Trajectories; Trauma; United States; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0160492

The risk of rehospitalization is elevated in the immediate post-discharge period and declines over time. It is not known if the extent and timing of risk vary across readmission diagnoses, suggesting that recovery and vulnerability after discharge differ by physiologic system. We compared risk trajectories for major readmission diagnoses in the year after discharge among all Medicare fee-for-service beneficiaries hospitalized with heart failure (HF), acute myocardial infarction (AMI), or pneumonia from 2008-2010. We estimated the daily risk of rehospitalization for 12 major readmission diagnostic categories after accounting for the competing risk of death after discharge. For each diagnostic category, we identified (1) the time required for readmission risk to peak and then decline 50% from maximum values after discharge; (2) the time required for readmission risk to approach plateau periods of minimal day-to-day change; and (3) the extent to which hospitalization risks are higher among patients recently discharged from the hospital compared with the general elderly population. Among >3,000,000 hospitalizations, the yearly rate of rehospitalization was 67.0%, 49.5%, and 55.3% after hospitalization for HF, AMI, and pneumonia, respectively. The extent and timing of risk varied by readmission diagnosis and initial admitting condition. Risk of readmission for gastrointestinal bleeding/anemia peaked particularly late after hospital discharge, occurring 10, 6, and 7 days after hospitalization for HF, AMI, and pneumonia, respectively. Risk of readmission for trauma/injury declined particularly slowly, requiring 38, 20, and 38 days to decline by 50% after hospitalization for HF, AMI, and pneumonia, respectively. Patterns of vulnerability to different conditions that cause rehospitalization vary by time after hospital discharge. This finding suggests that recovery of various physiologic systems occurs at different rates and that post-discharge interventions to minimize vulnerability to specific conditions should be tailored to their underlying risks.