(JAMA) - Heart attack, heart failure and pneumonia are three common conditions that often lead to hospitalizations for older patients. But what happens to these patients after they are treated for the initial problem and are discharged from the hospital?
A new study examined frequency, reasons for, and timing of re-hospitalization occurring within 30 days of hospital discharge.
Three common illnesses sending many older patients to the hospital are heart attack, heart failure and pneumonia. One in five of these patients end up being readmitted to the hospital within 30 days after they leave.
“The period after people leave the hospital is a very high risk period and there’s increasing attention about how we can make this a safer time for people,” said Harlan M. Krumholz, M.D., S.M., - Yale University School of Medicine.
“Even though they may make it through the initial hospitalization they remain at elevated risk for a broad range of new medical problems,” said Kumar Dharmarajan, M.D., M.B.A., - Yale New Haven Hospital.
Dr. Harlan Krumholz and Dr. Kumar Dharmarajan from the Center for Outcomes, Research and Evaluation at Yale New Haven Hospital and co-authors studied Medicare fee- for-service beneficiaries admitted to the hospital with these three common illnesses from 2007 to 2009.
Researchers studied what happened to patients during the first 30 days after discharge, how soon they were readmitted, the reason for rehospitalization and whether race, sex or ethnicity were associated with when and why they were readmitted.
“Two thirds of all those hospitalizations occurred in that early two weeks and the earlier the higher the risk. People remained at high risk throughout the month so despite the fact that the highest risk was early they still were in pretty high risk even two, three or four weeks after leaving the hospital,” said Dr. Krumholz.
“If they had a heart attack they may be at risk for things besides a heart attack after hospitalization such as bleeding, or an infection or a fall,” said Dr. Dharmarajan.
The study appears in JAMA, Journal of the American Medical Association.
“Whether they were older, younger, whether they were a different racial, ethnic group, a man or a woman, they were coming back in with the same conditions to a large degree,” said Dr. Dharmarajan.
Researchers say patients discharged from the hospital are just entering a second phase of their illness.
“You’ve finished phase one of care but phase two is getting better, recovery, convalescence and that is probably going to take active intervention. We need to provide support for patients as they get better, stronger, healthier probably over the whole month after they leave the hospital,” said Dr. Krumholz.
Researchers say hospitals that were least likely to provide outpatient follow-up within seven days after hospitalization for heart failure had the highest rates of readmissions within the first 30 days.