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After Hospital Discharge, Deadly Heart Risks Can Remain for Up to a Year

Findings could help hospitals set ‘realistic’ goals for recovery, Yale authors say

In the month following an older heart patient’s hospital discharge, there is a one-in-five risk of rehospitalization or death, but little is known about how these risks change over time. A new study by researchers at the Yale School of Medicine has found that risks remain high for up to a year, but can be addressed with targeted care.

Published in the February 6 issue of the BMJ, the study looked at 3 million Medicare patients aged 65 years or older who survived hospitalization for heart failure, acute myocardial infarction (MI), or pneumonia from 2008 to 2010. The investigators defined the absolute risks of rehospitalization and death on each day during the full year after discharge.

They found that the risk of rehospitalization and death declined slowly after hospital discharge and remained elevated for many months. They also found that specific risks vary by discharge diagnosis and outcomes over time. For example, the risk remained elevated for a longer period after hospitalization for heart failure compared with hospitalization for acute MI or pneumonia. For all three conditions, the risk of rehospitalization remained elevated for a longer period than the risk of death.

“If we can track absolute risks and their changes over time, this information will be critical in helping patients and hospitals set realistic expectations and goals for recovery, and plan for appropriate care after discharge,” said lead author Kumar Dharmarajan, MD. “As our health system increasingly focuses on improving long-term health and personalizing care, this information can help hospitals focus their interventions during the highest risk periods for patients.”

“Patients should remain vigilant for deterioration in health for an extended time after hospitalization,” Dharmarajan added. “This might mean checking in more often with a primary care physician or specialist.”

In future studies, Dharmarajan and his colleagues will seek to understand other factors that affect long-term risks and how to integrate this information into more-efficient and more-effective care plans.

Source: EurekAlert; February 6, 2015.

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