Heart Failure Readmission After Mitral Valve Repair and Replacement: Five-Year Follow-Up in the Medicare Population

• Published in: The Annals of thoracic surgery Vol. 98; no. 5; pp. 1544 - 1550
• Main Authors: Vassileva, Christina M., MD, Ghazanfari, Naseem, MD, Spertus, John, MD, McNeely, Christian, BS, Markwell, Stephen, MA, Hazelrigg, Stephen, MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.11.2014
• Subjects: Aged; Cardiothoracic Surgery; Female; Follow-Up Studies; Heart Failure - epidemiology; Heart Failure - etiology; Heart Valve Prosthesis Implantation - adverse effects; Humans; Incidence; Male; Medicare; Mitral Valve Stenosis - surgery; Patient Readmission - trends; Postoperative Complications; Retrospective Studies; Surgery; Survival Rate - trends; Time Factors; United States - epidemiology; United States; 18
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2014.07.040

Background Readmission rates are well established as a quality indicator for heart failure (HF). We analyzed HF readmission rates after mitral valve repair (MVP) and replacement (MVR). Methods We included 21,138 Medicare beneficiaries with primary isolated MVP (n = 6,896) or MVR (n = 14,242) from 2000 through 2004. Readmission rates were identified using MedPar records subsequent to the index procedure during a 5-year follow-up. Treating death as a competing risk, cumulative readmission incidences were analyzed and stratified by presence or absence of preoperative HF. Results Preoperative HF was present in 61.0% of the patients. All-cause readmission rates were 24.9% at 30 days and 78.0% at 5 years. The cumulative incidence of readmission for HF remained almost 3 times higher in patients with preoperative HF compared with those without for MVP (2.1% vs 5.9% in 30 days and 10.3% vs 26.3% in 5 years) and 2 times higher for MVR (3.6% vs 7.4% in 30 days and 15.8% vs 30.4% in 5 years). Regardless of procedure type, patients without preoperative HF had significantly lower HF readmission rates (3.0% vs 7.0% in the first 30 days and 13.6% vs 29.2% after 5 years) ( p  = 0.0001). Conclusions Hospital readmission after mitral surgery is high. Preoperative heart failure is associated with higher postoperative readmission rates. Because admission for heart failure accounts for a significant proportion of these readmissions, close follow-up of patients with known mitral valve disease and referral to surgery prior to development of heart failure may decrease postoperative readmission rates.