Context For more than a decade, hospitals have focused on decreasing length of stay but this focus may have had unanticipated effects on patient care. Objective To describe the temporal changes in length of stay, discharge disposition, and short-term outcomes among older patients hospitalized for heart failure. Methods Observational study of Medicare fee-for-service hospitalizations for heart failure between 1993 and 2008, with a 30-day follow-up. Main Outcome Measures Length of hospital stay, in-patient and 30-day mortality, and 30-day readmission rates. Results Between 1993 and 2008, 7,799,788 hospitalizations were studied. Length of stay decreased from 8.8 (95% CI, 8.8–8.8) to 6.3 (95% CI, 6.3–6.3) days. In-hospital mortality decreased by half, from 8.5% (95%CI, 8.4–8.6) in 1993 to 4.2% (95%CI, 4.2–4.3%) in 2008, whereas 30-day mortality decreased by 17%, from 12.8% (95%CI, 12.8–12.9%) to 10.9% (95%CI, 10.8–10.9%). Rates of discharge to home decreased 10% (from 74.4% to 66.9%), while discharges to skilled nursing facilities increased 65%, from 13% to 21.3%. Thirty-day readmission rates increased 27%, from 17.2% (95%CI, 17.1–17.3%) relative to 21.9% (95%CI, 21.8–22.0%) (all p values <0.001). Consistent with our unadjusted analyses, 2007–2008 risk-adjusted 30-day mortality risk was 0.86 (95% CI, 0.86–0.87) when compared with 1993–1994, while the 30-day readmission risk ratio was 1.19 (95%CI, 1.18–1.21). Conclusions For patients admitted with heart failure over the past 16 years, we observed reductions in length of stay and in-hospital mortality, less marked reductions in 30-day mortality, and increases in 30-day readmission rates and use of skilled nursing facilities after discharge.

Background-In July 2009, Medicare began publicly reporting hospitals' risk-standardized 30-day all-cause readmission rates (RSRRs) among fee-for-service beneficiaries discharged after hospitalization for heart failure from all the US acute care nonfederal hospitals. No recent national trends in RSRRs have been reported, and it is not known whether hospital-specific performance is improving or variation in performance is decreasing. used 2004 -2006 Medicare administrative data to identify all fee-for-service beneficiaries admitted to a US acute care hospital for heart failure and discharged alive. We estimated mean annual RSRRs, a National Quality Forum-endorsed metric for quality, using 2-level hierarchical models that accounted for age, sex, and multiple comorbidities; variation in quality was estimated by the SD of the RSRRs. There were 570 996 distinct hospitalizations for heart failure in which the patient was discharged alive in 4728 Methods and Results-We

A multicomponent, nonpharmacological intervention integrated into routine practice reduces delirium during hospitalization in older patients, improves quality of care, and can be implemented without additional resources in a public healthcare system.

Aims The aim of this study was to evaluate the prevalence, clinical features, and the independent impact of frailty—a geriatric syndrome characterized by the decline of physiological systems—and its components, on prognosis after heart failure (HF) hospitalization. Methods and results FRAIL‐HF is a prospective cohort study including 450 non‐dependent patients ≥70 years old hospitalized for HF. Frailty was screened according to the biological phenotype criteria (low physical activity, weight loss, slow walking speed, weak grip strength, and exhaustion). The independent influence of frailty on mortality, functional decline, and readmission risks was calculated adjusted for HF characteristics and co‐morbidities. Mean age was 80 ± 6 years; 76% fulfilled frailty criteria. Frail patients were older, more often female, but showed no differences in chronic co‐morbidities, LVEF, and NT‐proBNP levels. Slow walking speed was the most discriminative component between frail (89.2%) and non‐frail patients (26%). Overall, 1‐year survival was 89% in the non‐frail group and 75% in frail subjects (P = 0.003). After adjusting for age, gender, chronic and acute co‐morbidities, NYHA, and NT‐proBNP, frail patients showed higher risks for 30‐day functional decline [odds ratio (OR) 2.20, 95% confidence interval (CI) 1.19–4.08], 1‐year all‐cause mortality [hazard ratio (HR) 2.13, 95% CI 1.07–4.23], and 1‐year readmission (OR 1.96, 95% CI 1.14–3.34). The association of individual components with 1‐year adjusted mortality risk was HR 2.14, 95% CI 1.05–4.39 for low physical activity and HR 1.77, 95% CI 0.95–3.29 for slow walking speed. Conclusion Frailty is highly prevalent even among non‐dependent elderly HF patients, and is an independent predictor of early disability, long‐term mortality, and readmission. Individual frailty components may be useful for risk prediction.