The US Centers for Medicare and Medicaid Services Hospital Readmission Reduction Program penalizes hospitals with high risk-adjusted 30-day readmission after myocardial infarction (MI). Using the National Cardiovascular Data Registry/Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With the Guidelines, Pandey and coauthors studied the association of readmission rates with MI care processes. Among 380 hospitals that treated 176 644 patients with MI from 2008 through 2011, there was no significant association between readmission rates and adherence to MI performance measures. Thirty-day readmission rates were not associated with subsequent readmission rates in landmark analyses beginning 30 days after discharge and were not associated with risk for mortality within 1 year of discharge.
Author Audio Interview
Transcatheter aortic valve replacement (TAVR) use is increasing rapidly in the United States, but the 30-day readmission rate after TAVR is nearly 18%. To examine the association between institutional TAVR volume and rates, causes, and costs of 30-day readmissions, Khera and coauthors evaluated 129 hospitals with TAVR programs in 2014 using the Nationwide Readmissions Database. High-volume hospitals that performed 100 or more TAVRs per year had significantly lower readmission rates than medium-volume (50 to less than 100) and low-volume (less than 50) centers. In an editorial, Carroll stresses that promotion of best practices and commitment to quality improvement should be a requirement for both low-volume and higher-volume TAVR programs.
Editorial and Editor’s Note
Implantable cardioverter defibrillators (ICDs) improve survival in patients with left ventricular ejection fraction (EF) <35%. To determine whether ICDs enhance survival in those in whom EF improves with medical therapy, Adabag and coauthors studied 1273 participants in the Sudden Cardiac Death in Heart Failure Trial. During a median follow-up of 30 months, the all-cause mortality rate was lower in the ICD vs the placebo group; compared with placebo, the adjusted hazard ratio for the effect of ICD on mortality was 0.64 (95% CI, 0.48-0.85) in patients with a repeated EF ≤35% and 0.62 (95% CI, 0.29-1.30) in those with a repeated EF >35%. Prospective trials are needed to test ICD efficacy in patients with an EF >35%.
Despite major improvements in control of cardiovascular disease (CVD) risk factors, whether adults in all socioeconomic strata have benefited equally is uncertain. Odutayo and coauthors performed a cross-sectional analysis of 17 199 adults enrolled in the 1999 to 2014 National Health and Nutrition Examination Survey. For adults with incomes at or below the poverty line, there was little change in the percentage of adults with 10-year CVD risk of 20% or more, mean systolic blood pressure, and the percentage of current smokers, whereas these variables decreased significantly across survey years in those in the high-income stratum. These findings suggest that efforts to control CVD risk have not benefited adults in each socioeconomic stratum equally.