Death Risk Remains High After Hospital Discharge

A new study reveals that after hospital discharge, readmission and death risk declines slowly and can remain higher for up to a year.

Researchers at Yale University (New Haven, CT, USA) and Columbia University Medical Center (CUMC; New York, NY, USA) conducted a retrospective cohort study involving more than three million Medicare beneficiaries (aged 65 years or more) in 4,767 hospitals across the United States, all of whom survived hospitalization for heart failure (HF), acute myocardial infarction (MI), or pneumonia. The main outcome measures were daily absolute risks of first readmission to hospital and death for one year after discharge.

The researchers found that within one year of hospital discharge, readmission to hospital and death, respectively, occurred following 67.4% and 35.8% of hospitalizations for HF, 49.9% and 25.1% for acute MI, and 55.6% and 31.1% for pneumonia. After hospitalization, the magnitude of the relative risk for hospital admission over the first 90 days was 8, 6, and 6 times greater than that of the general older population, while the relative risk of death was 11, 8, and 10 times greater, respectively. The study was published in the February 6, 2015, issue of the British Medical Journal (BMJ).

“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,” said lead author Kumar Dharmarajan, MD, an assistant professor of cardiology at the Yale School of Medicine. “Patients should remain vigilant for deterioration in health for an extended time after hospitalization. This might mean checking in more often with a primary care physician or specialist.”

Patients are vulnerable to major adverse outcomes and a broad range of illnesses after hospital stay, and this period of heightened and generalized vulnerability to a spectrum of conditions has been termed the post-hospital syndrome. Readmissions are common, with nearly one in five adults aged more than 65 readmitted within 30 days of discharge. Death is also common in this first month, during which rates of post-discharge mortality may exceed those of initial inpatient mortality.

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Yale University
Columbia University Medical Center