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Brief Report
June 17, 2020

Trends in Readmission and Mortality Rates Following Heart Failure Hospitalization in the Veterans Affairs Health Care System From 2007 to 2017

Author Affiliations
  • 1Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
  • 2Keio University School of Medicine, Tokyo, Japan
  • 3Division of Cardiology, University of California Los Angeles, Los Angeles
  • 4Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
JAMA Cardiol. Published online June 17, 2020. doi:10.1001/jamacardio.2020.2028
Key Points

Question  From 2007 to 2017, an era of focus on reducing heart failure readmissions, how did readmission and mortality rates after heart failure admission change in the Veterans Affairs Health Care System?

Findings  This cohort study of 304 374 heart failure hospital admissions from 164 566 patients from January 2007 to September 2017 shows that after risk adjustment, the odds of readmission steadily declined, but there was no significant change in mortality rates.

Meaning  Per this analysis, patients in the Veterans Affairs Health Care System have experienced similar heart failure readmission rate reductions as Medicare patients in Inpatient Prospective Payment System Hospitals, without a change in mortality despite use of nonfinancial incentives.


Importance  The Centers for Medicare & Medicaid Services and the Veterans Affairs Health Care System provide incentives for hospitals to reduce 30-day readmission and mortality rates. In contrast with the large body of evidence describing readmission and mortality in the Medicare system, it is unclear how heart failure readmission and mortality rates have changed during this period in the Veterans Affairs Health Care System.

Objectives  To evaluate trends in readmission and mortality after heart failure admission in the Veterans Affairs Health Care System, which had no financial penalties, in a decade involving focus on heart failure readmission reduction (2007-2017).

Design, Setting, and Participants  This cohort study used data from all Veterans Affairs–paid heart failure admissions from January 2007 to September 2017. All Veterans Affairs–paid hospital admissions to Veterans Affairs and non–Veterans Affairs facilities for a primary diagnosis of heart failure were included, when the admission was paid for by the Veterans Affairs. Data analyses were conducted from October 2018 to March 2020.

Exposures  Admission for a primary diagnosis of heart failure at discharge.

Main Outcomes and Measures  Thirty-day all-cause readmission and mortality rates.

Results  A total of 164 566 patients with 304 374 hospital admissions were included. Among the 304 374 hospital admissions between 2007 and 2017, 298 260 (98.0%) were for male patients, and 195 205 (64.4%) were for white patients. The mean (SD) age was 70.8 (11.5) years. The adjusted odds ratio of 30-day readmission declined throughout the study period to 0.85 (95% CI, 0.83-0.88) in 2015 to 2017 compared with 2007 to 2008. The adjusted odds ratio of 30-day mortality remained stable, with an adjusted odds ratio of 1.01 (95% CI, 0.96-1.06) in 2015 to 2017 compared with 2007 to 2008. Stratification by left ventricular ejection fraction showed similar readmission reduction trends and no significant change in mortality, regardless of strata.

Conclusions and Relevance  In this analysis of an integrated health care system that provided guidance and nonfinancial incentives for reducing readmissions, such as public reporting of readmission rates, risk-adjusted 30-day readmission declined despite inclusion of clinical variables in risk adjustment, but mortality did not decline. Future investigations should focus on evaluating the effectiveness of specific approaches to readmission reduction to inform efficient and effective application in individual health systems, hospitals, and practices.