Risk of adverse events changes over time following hospitalization

Readmissions and death after hospitalization are common.  However, there no data on how the risk for these adverse events changes over time following hospitalization.  In this study, the authors explored the absolute risk and changes in risk over time for readmission and mortality in the year following hospitalization for myocardial infarction (MI), pneumonia or heart failure (HF) among more than 3 million Medicare fee-for-service beneficiaries.  The risk of readmission was highest in the first few days following discharge for all three conditions (Figure 1).  The risk of readmission declined by 50% by day 13 after discharge following hospitalization for MI and day 38 after discharge following hospitalization for HF.  However, the risk of hospitalization remained elevated in the year following discharge for these three conditions relative to the general Medicare population (Figure 2).  The risk of mortality was highest on day 1 after hospitalization for all three conditions.

Conclusions: This study demonstrates the risk of readmission and death following hospitalization for MI, HF, and PNA is highest immediately following hospital discharge.  Although these risks decreased fairly rapidly following hospital discharge, these risks remain elevated relative to the general population for the entire year following hospitalization. This extended period of risk is not currently recognized in the majority of interventions to reduce readmissions and mortality.

Summarized by Javier A. Valle and Steven M. Bradley

  • Dharmarajan K, Hsieh AF, Kulkarni VT,  et al. Trajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia: retrospective cohort study.  BMJ. 2015 Feb 5;350:h411

Figure 1: Figure 1                                                                                                                                     Figure 2:

Figure 2

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