13 Nov Going the Wrong Way: ACA’s Readmission Reduction Program Linked To Increased Heart Failure Deaths
MedicalResearch.com Interview with:
Ankur Gupta, MD, PhD
Division of Cardiovascular Medicine
Brigham and Women’s Hospital Heart & Vascular Center and
Harvard Medical School,
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The Hospital Readmissions Reduction Program (HRRP), established under the Affordable Care Act, aimed to reduce readmissions from various medical conditions including heart failure – the leading cause of readmissions among Medicare beneficiaries. The program financially penalizes hospitals with high readmission rates. However, there have been concerns of unintended consequences especially on mortality due to this program.
Using American Heart Association’s Get With The Guidelines-Heart Failure (GWTG-HF) data linked to Medicare data, we found that the policy of reducing readmissions after heart failure hospitalizations was associated with reduction in 30-day and 1-year readmissions yet an increase in 30-day and 1-year mortality.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: A policy focus on reducing readmissions in heart failure is misguided. Instead, policies to improve care of patients with heart failure should directly focus on improving quality of care and outcomes in these patients.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We are investigating the type of hospitals and patients with heart failure that are most likely to be adversely affected by this policy.
MedicalResearch.com: Is there anything else you would like to add?
Response: Like drugs and devices, health care policies should be rigorously tested in randomized trials before their wide-spread adoption.
The study was funded in part by the AHA GWTG-HF young investigator seed grant award to Dr. Ankur Gupta and the NIH grant number 5T32HL094301. The American Heart Association provides the Get With The Guidelines Heart Failure program (GWTG-HF). GWTG-HF is sponsored, in part, by Amgen Cardiovascular and has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable.
Dr. Larry Allen reports funding from NIH, PCORI and AHA, and consulting with Novartis and Janssen. Dr. Deepak L. Bhatt discloses the following relationships – Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott); Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, PLx Pharma, Takeda. Dr. Adam D. DeVore reports research support from the American Heart Association, Amgen, and Novartis and consulting with Novartis. Dr Gregg Fonarow reports research support from NIH, consulting with Abbott, Amgen, Novartis, and Medtronic, and serving as a GWTG Steering Committee member. All other authors have nothing to disclose.
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AHA 2017 abstract and JAMA Cardiology publication:
Gupta A, Allen LA, Bhatt DL, Cox M, DeVore AD, Heidenreich PA, Hernandez AF, Peterson ED, Matsouaka RA, Yancy CW, Fonarow GC. Association of the Hospital Readmissions Reduction Program Implementation With Readmission and Mortality Outcomes in Heart Failure. JAMA Cardiol. Published online November 12, 2017. doi:10.1001/jamacardio.2017.4265
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