In Reply We thank Lin and Li for their interest in our article.1 With respect to their first point, we agree that younger Canadian patients are healthier than younger US Medicare patients (who are only eligible for Medicare if receiving Social Security Disability Insurance benefits), which is why we reported sensitivity analyses by age (as well as length of stay) in Table 3.1 We also reported that, like older American patients, length of stay for Canadian patients older than 65 years changed little (from 7.6 days to 7.4 days) between 2005 and 2015. The readmission rates for Canadians older than 65 years closely mirrored those reported for the full cohort in all time quarters, with no statistically significant changes on segmented regression analyses after April 2010 or October 2012, consistent with our overall results.
McAlister FA, Youngson E. Substantial Differences Between Cohorts of Patients Hospitalized With Heart Failure in Canada and the United States—Reply. JAMA Cardiol. Published online September 18, 2019. doi:https://doi.org/10.1001/jamacardio.2019.3317
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