4053.0: Tuesday, November 14, 2000 - 9:00 AM

Abstract #6826

Hospital readmission rates associated with the dose of angiotensin converting enzyme inhibitor (ACEI) among patients hospitalized with congestive heart failure due to left ventricular systolic dysfunction

Jean-Christophe Luthi, MD, MPH1, Mary-Jo Lund, MSPH2, Laura Sampietro-Colom, MD, MSPH3, William M. McClellan, MD, MPH4, and David G. Kleinbaum, PhD2. (1) Health Care Evaluation Unit, University Institute of Social and Preventive Medicine, Epidemiology Department, Emory University, Bugnon 17, Lausanne, Switzerland, 41 21 314 7254, Jean-Christophe.Luthi@inst.hospvd.ch, (2) Epidemiology Department, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, (3) Agencia d'Avaluacio de Tecnologia Medica, Travessera de les Corts 131-159, Pavello Ave Maria, Barcelona, Spain, (4) Georgia Medical Care Foundation, 57, Executive Park South, Suite 200, Atlanta, GA 30329

Objective. Recent clinical trials have shown that treatment with ACEI reduces readmission among patients hospitalized with left ventricular systolic dysfunction (LVSD). This evidence has been incorporated into clinical practice guidelines. The purpose of this study is to examine the relationship between ACEI dose and hospital readmission rates among patients with LVSD. Methods. We abstracted records from 2,943 Medicare beneficiaries hospitalized for CHF in 69 hospitals. The presence of LVSD was determined from recorded ejection fractions or a narrative description of ventricular function. Subsequent readmission was tracked over a 21 month period using Health Care Finance Administration MEDPRO files. We implemented a multivariate repeated measure analysis using Poisson regression and generalized estimating equations, (GEE) procedures. Results. There were 611 patients with LVSD documented in the medical record. Compared to target dose ACEI, the crude rate ratios (95% CI) were 1.31 (1.11 1.56) for sub-target dose ACEI and 1.70 (1.40 2.07) for ACEI not prescribed. The adjusted rate ratios (95% CI) using a compound symmetric correlation structure were 1.24 (0.91 1.69) for less then target dose ACEI and 1.74 (1.22 2.48) for ACEI not prescribed (p=0.005). Conclusions. We found a clinically important, gradient decreased rate of readmission among CHF patients with LVSD who were treated with a target dose ACEI compared to patients receiving sub-target doses of ACEI and patients who were not treated with ACEI. Our findings suggest that compliance with ACEI prescribing recommendations listed in clinical practice guidelines for patients with CHF due to LVSD confers benefit.

Learning Objectives: Through attendance participants will acquire information about quality improvement and outcome research. At the end of the session, the learner in this session will be able to: - discuss the importance of compliance to clinical practice guidelines (process of care). - identify an outcome quality indicator. During this presentation recent research findings regarding the relationships between process and outcome quality indicators will be discussed

Keywords: Outcomes Research, Quality Improvement

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA