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Circ Cardiovasc Qual Outcomes. 2017 May;10(5). pii: e003271. doi: 10.1161/CIRCOUTCOMES.116.003271.

Sex Differences in Trajectories of Risk After Rehospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia.

Author information

1
From the Center for Outcomes Research and Evaluation (CORE), Yale New Haven Health, CT (R.P.D., K.D., A.F.H., J.W., L.Q., H.M.K.); and Department of Emergency Medicine (R.P.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (K.D., H.M.K.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), and Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT. rachel.dreyer@yale.edu.
2
From the Center for Outcomes Research and Evaluation (CORE), Yale New Haven Health, CT (R.P.D., K.D., A.F.H., J.W., L.Q., H.M.K.); and Department of Emergency Medicine (R.P.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (K.D., H.M.K.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), and Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT.

Abstract

BACKGROUND:

Women have an increased risk of rehospitalization in the immediate postdischarge period; however, few studies have determined how readmission risk dynamically changes on a day-to-day basis over the full year after hospitalization by sex and how these differences compare with the risk for mortality.

METHODS AND RESULTS:

We identified >3 000 000 hospitalizations of patients with a principal discharge diagnosis of heart failure, acute myocardial infarction, or pneumonia and estimated sex differences in the daily risk of rehospitalization/death 1 year after discharge from a population of Medicare fee-for-service beneficiaries aged 65 years and older. We calculated the (1) time required for adjusted rehospitalization/mortality risks to decline 50% from maximum values after discharge, (2) time required for the adjusted readmission risk to approach plateau periods of minimal day-to-day change, and (3) extent to which adjusted risks are greater among recently hospitalized patients versus Medicare patients. We identified 1 392 289, 530 771, and 1 125 231 hospitalizations for heart failure, acute myocardial infarction, and pneumonia, respectively. The adjusted daily risk of rehospitalization varied by admitting condition (hazard rate ratio for women versus men, 1.10 for acute myocardial infarction; hazard rate ratio, 1.04 for heart failure; and hazard rate ratio, 0.98 for pneumonia). However, for all conditions, the adjusted daily risk of death was higher among men versus women (hazard rate ratio women versus with men, <1). For both sexes, there was a similar timing of peak daily risk, half daily risk, and reaching plateau.

CONCLUSIONS:

Although the association of sex with daily risk of rehospitalization varies across conditions, women are at highest risk after discharge for acute myocardial infarction. Future studies should focus on understanding the determinants of sex differences in rehospitalization risk among conditions.

KEYWORDS:

heart failure; hospitalization; myocardial infarction; pneumonia; women

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