CLINICAL
NEWS JOURNAL WRAP
Kim Eagle, MD, and the editors of ACC.org, present relevant
articles taken from various journals.
Study Assesses Trends in
Readmissions and Use of
Observation Units
Readmission rates for both targeted
and non-targeted conditions are
decreasing, and changes in observation-unit stays did not account for
the decrease in readmissions. These
trends are consistent with hospitals’
response to incentives to reduce readmissions, including financial penalties
for readmissions, according to a study
published Feb. 24 in the New England
Journal of Medicine.
Rachael B. Zuckerman, MPH,
the Office of the Assistant Secretary
for Planning and Evaluation, Department of Health and Human Services,
Washington, DC, et al., looked at
monthly, hospital-level rates of
readmission and observation-service
use within 30 days after hospital
discharge among Medicare elderly
beneficiaries from Oct. 2007, to May
2015 at 3,387 hospitals.
Results showed that readmission
rates for targeted conditions—acute
myocardial infarction, heart failure
and pneumonia—declined from
21.5%–17.8%, while rates from nontargeted conditions declined from
15.3%–13.1%. Further, Zuckerman,
et al., found that rates began to fall
faster in April 2010, after the passage
of the Affordable Care Act (ACA), and
continued to decline at a slower rate.
They also found that the rate of
observation-service use for targeted
and non-targeted conditions increased
throughout the study period, but
there was “no significant association”
within hospitals between increases in
observation service use and reductions in readmission.
The authors conclude that the
change in rate of readmissions suggests that the Hospital Readmissions
Reduction Program, which is included
in the ACA, “may have had a broad
effect on care, especially for targeted
conditions.” The authors add that
ACC.org/CSWN
moving forward, “given the change in
patterns of care during the analysis
period, it will be important to continue monitoring these trends.”
Zuckerman RB, Steven H. Sheingold SH,
Orav EJ, et al. N Engl J Med. 2016;doi:
10.1056/NEJMsa1513024.
Studies Examine
CVD Care in Women
Women may be less likely than men
to receive optimal care at hospital discharge when admitted for coronary
artery disease (CAD), according to a
study published Feb. 23 in a special
women’s issue of Circulation: Cardiovascular Quality and Outcomes.
The study, led by Deepak L.
Bhatt, MD, MPH, looked at 49,358
patients ages 65 and older across
366 U.S. hospitals. Results showed
that, compared with men, women
were less likely to receive optimal
care, and were more likely to have
higher mortality if sub-optimal care
was received. Further, African-Americans, compared with whites, were
also more likely to die from CAD,
though this disparity could not be
accounted for by differences in the
quality of care.
The authors ultimately conclude
that “approximately 69% of the sex
disparity in mortality could potentially be reduced or greatly eliminated
by providing optimal and equitable
quality of care [to women].”
A separate study by Kim Lavoie,
PhD, University of Quebec at Montreal, et al., found that anxiety
symptoms might mask cardiovascular
disease symptoms among women—
but not men—and may contribute
to referral and diagnostic delays for
women.
The study looked at 2,342 patients
who underwent a SPECT exercise
stress test and underwent a psychi-
Results showed
that, compared
with men, women
[...] were more
likely to have
higher mortality
if sub-optimal
care was received.
atric interview to assess mood and
anxiety disorders. Results showed
that in those without a history of
CAD, women with anxiety were more
likely to exhibit ischemia during
exercise compared to women without
anxiety. No significant effects were
observed for men.
The authors conclude that, moving forward, additional research is
needed to confirm these findings, and
that “future work should also investigate the extent to which psychiatric
disorders affect care trajectory and/
or CAD outcomes among men and
women, and whether interventions
to improve psychiatric status among
those with or at risk for CAD could
improve outcomes.”
Li S, Fonarow GC, Mukamal KJ, et al. Circ
Cardiovasc Qual Outcomes. 2016; 9:S36-S44.
Paine NJ, Bacon SL, Pelletier R, et al. Circ
Cardiovasc Qual Outcomes. 2016; 9:S53-S61.
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