1. Sex Differences in Trajectories of Risk After Rehospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia.
- Author
-
Dreyer RP, Dharmarajan K, Hsieh AF, Welsh J, Qin L, and Krumholz HM
- Subjects
- Aged, Aged, 80 and over, Fee-for-Service Plans, Female, Heart Failure epidemiology, Humans, Incidence, Male, Medicare, Myocardial Infarction epidemiology, Patient Readmission economics, Pneumonia epidemiology, Retrospective Studies, Risk Factors, Sex Distribution, Sex Factors, United States epidemiology, Heart Failure therapy, Myocardial Infarction therapy, Patient Readmission trends, Pneumonia therapy, Risk Assessment methods
- Abstract
Background: Women have an increased risk of rehospitalization in the immediate postdischarge period; however, few studies have determined how readmission risk dynamically changes on a day-to-day basis over the full year after hospitalization by sex and how these differences compare with the risk for mortality., Methods and Results: We identified >3 000 000 hospitalizations of patients with a principal discharge diagnosis of heart failure, acute myocardial infarction, or pneumonia and estimated sex differences in the daily risk of rehospitalization/death 1 year after discharge from a population of Medicare fee-for-service beneficiaries aged 65 years and older. We calculated the (1) time required for adjusted rehospitalization/mortality risks to decline 50% from maximum values after discharge, (2) time required for the adjusted readmission risk to approach plateau periods of minimal day-to-day change, and (3) extent to which adjusted risks are greater among recently hospitalized patients versus Medicare patients. We identified 1 392 289, 530 771, and 1 125 231 hospitalizations for heart failure, acute myocardial infarction, and pneumonia, respectively. The adjusted daily risk of rehospitalization varied by admitting condition (hazard rate ratio for women versus men, 1.10 for acute myocardial infarction; hazard rate ratio, 1.04 for heart failure; and hazard rate ratio, 0.98 for pneumonia). However, for all conditions, the adjusted daily risk of death was higher among men versus women (hazard rate ratio women versus with men, <1). For both sexes, there was a similar timing of peak daily risk, half daily risk, and reaching plateau., Conclusions: Although the association of sex with daily risk of rehospitalization varies across conditions, women are at highest risk after discharge for acute myocardial infarction. Future studies should focus on understanding the determinants of sex differences in rehospitalization risk among conditions., (© 2017 American Heart Association, Inc.)
- Published
- 2017
- Full Text
- View/download PDF