Accepted Manuscript Beta-Blocker Use and 30-Day All-Cause Readmission in Medicare Beneficiaries with Systolic Heart Failure Vikas Bhatia, MD, Navkaranbir S. Bajaj, MD, Kumar Sanam, MD, Taimoor Hashim, MD, Charity J. Morgan, PhD, Sumanth D. Prabhu, MD, Gregg C. Fonarow, MD, Prakash Deedwania, MD, Javed Butler, MD, MPH, Peter Carson, MD, Thomas E. Love, PhD, Raya Kheirbek, MD, Wilbert S. Aronow, MD, Stefan D. Anker, MD, PhD, Finn Waagstein, MD, PhD, Ross Fletcher, MD, Richard M. Allman, MD, Ali Ahmed, MD, MPH PII:
S0002-9343(14)01218-2
DOI:
10.1016/j.amjmed.2014.11.036
Reference:
AJM 12812
To appear in:
The American Journal of Medicine
Received Date: 7 May 2014 Revised Date:
23 October 2014
Accepted Date: 22 November 2014
Please cite this article as: Bhatia V, Bajaj NS, Sanam K, Hashim T, Morgan CJ, Prabhu SD, Fonarow GC, Deedwania P, Butler J, Carson P, Love TE, Kheirbek R, Aronow WS, Anker SD, Waagstein F, Fletcher R, Allman RM, Ahmed A, Beta-Blocker Use and 30-Day All-Cause Readmission in Medicare Beneficiaries with Systolic Heart Failure, The American Journal of Medicine (2015), doi: 10.1016/ j.amjmed.2014.11.036. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Beta-Blocker Use and 30-Day All-Cause Readmission in Medicare Beneficiaries with Systolic Heart Failure
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Vikas Bhatia, MD,a,b Navkaranbir S. Bajaj, MD,a,b Kumar Sanam, MD,a Taimoor Hashim, MD,a Charity J. Morgan, PhD,a Sumanth D. Prabhu, MD,a,b Gregg C. Fonarow, MD,c Prakash Deedwania, MD,d Javed Butler, MD, MPH,e Peter Carson, MD,f Thomas E. Love, PhD,g Raya Kheirbek, MD,f Wilbert S. Aronow, MD,h Stefan D. Anker, MD, PhD,i Finn Waagstein, MD, PhD,j Ross Fletcher,g MD, Richard M. Allman, MD,k Ali Ahmed MD, MPHa,b a
SC
University of Alabama at Birmingham, Birmingham, AL; Veterans Affairs Medical Center, Birmingham, AL; c University of California, Los Angeles, CA; d University of California, San Francisco, Fresno, CA; e Emory University, Atlanta, GA; f Veterans Affairs Medical Center, Washington, DC; g Case Western Reserve University, Cleveland, OH, USA; h New York Medical College, Valhalla, NY; i Department of Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen j University of Gothenburg, Gothenburg, Sweden k Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC
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Corresponding author: Vikas Bhatia, MD, 1720 2nd Ave South, CH19-219, Birmingham AL 352942041; Telephone: 1-205-934-9632; Fax: 1-205-975-7099; Email: [email protected] mailto:[email protected] Key words: Systolic heart failure, Older adults, Beta blockers, Hospitalization, Readmission
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Word count: (including abstract, text, and acknowledgements): 2240 None of the authors have any conflict of interest to disclose All authors had access to the data and a role in writing the manuscript Running head: B-blocker and 30 day readmission in heart failure
ACCEPTED MANUSCRIPT Page 2 of 17
BACKGROUND: Beta-blockers improve outcomes in patients with systolic heart failure. However, it is unknown whether their initial negative inotropic effect may increase 30-day all-cause
RI PT
readmission, a target outcome for Medicare cost reduction and financial penalty for hospitals under the Affordable Care Act.
METHODS: Of the 3067 Medicare beneficiaries, discharged alive from 106 Alabama hospitals
SC
(1998-2001) with a primary discharge diagnosis of heart failure and ejection fraction 80% and
M AN U
Kappa values >0.60.6
New Use of Beta-Blockers: Assembly of an Inception Cohort
Of the 8555 patients, 8049 were discharged alive, of these, 5479 (68%) had data on left ventricular ejection fraction, of which 3067 (68%) had ejection fraction
S0002-9343(14)01218-2
DOI:
10.1016/j.amjmed.2014.11.036
Reference:
AJM 12812
To appear in:
The American Journal of Medicine
Received Date: 7 May 2014 Revised Date:
23 October 2014
Accepted Date: 22 November 2014
Please cite this article as: Bhatia V, Bajaj NS, Sanam K, Hashim T, Morgan CJ, Prabhu SD, Fonarow GC, Deedwania P, Butler J, Carson P, Love TE, Kheirbek R, Aronow WS, Anker SD, Waagstein F, Fletcher R, Allman RM, Ahmed A, Beta-Blocker Use and 30-Day All-Cause Readmission in Medicare Beneficiaries with Systolic Heart Failure, The American Journal of Medicine (2015), doi: 10.1016/ j.amjmed.2014.11.036. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Beta-Blocker Use and 30-Day All-Cause Readmission in Medicare Beneficiaries with Systolic Heart Failure
RI PT
Vikas Bhatia, MD,a,b Navkaranbir S. Bajaj, MD,a,b Kumar Sanam, MD,a Taimoor Hashim, MD,a Charity J. Morgan, PhD,a Sumanth D. Prabhu, MD,a,b Gregg C. Fonarow, MD,c Prakash Deedwania, MD,d Javed Butler, MD, MPH,e Peter Carson, MD,f Thomas E. Love, PhD,g Raya Kheirbek, MD,f Wilbert S. Aronow, MD,h Stefan D. Anker, MD, PhD,i Finn Waagstein, MD, PhD,j Ross Fletcher,g MD, Richard M. Allman, MD,k Ali Ahmed MD, MPHa,b a
SC
University of Alabama at Birmingham, Birmingham, AL; Veterans Affairs Medical Center, Birmingham, AL; c University of California, Los Angeles, CA; d University of California, San Francisco, Fresno, CA; e Emory University, Atlanta, GA; f Veterans Affairs Medical Center, Washington, DC; g Case Western Reserve University, Cleveland, OH, USA; h New York Medical College, Valhalla, NY; i Department of Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen j University of Gothenburg, Gothenburg, Sweden k Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC
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M AN U
b
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Corresponding author: Vikas Bhatia, MD, 1720 2nd Ave South, CH19-219, Birmingham AL 352942041; Telephone: 1-205-934-9632; Fax: 1-205-975-7099; Email: [email protected] mailto:[email protected] Key words: Systolic heart failure, Older adults, Beta blockers, Hospitalization, Readmission
AC C
Word count: (including abstract, text, and acknowledgements): 2240 None of the authors have any conflict of interest to disclose All authors had access to the data and a role in writing the manuscript Running head: B-blocker and 30 day readmission in heart failure
ACCEPTED MANUSCRIPT Page 2 of 17
BACKGROUND: Beta-blockers improve outcomes in patients with systolic heart failure. However, it is unknown whether their initial negative inotropic effect may increase 30-day all-cause
RI PT
readmission, a target outcome for Medicare cost reduction and financial penalty for hospitals under the Affordable Care Act.
METHODS: Of the 3067 Medicare beneficiaries, discharged alive from 106 Alabama hospitals
SC
(1998-2001) with a primary discharge diagnosis of heart failure and ejection fraction 80% and
M AN U
Kappa values >0.60.6
New Use of Beta-Blockers: Assembly of an Inception Cohort
Of the 8555 patients, 8049 were discharged alive, of these, 5479 (68%) had data on left ventricular ejection fraction, of which 3067 (68%) had ejection fraction
