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Original Articles

Mortality and Readmission for Patients With Heart Failure Among U.S. News & World Report’s Top Heart Hospitals

Gregory K. Mulvey, BA; Yun Wang, PhD; Zhenqiu Lin, PhD; Oliver J. Wang, MD; Jersey Chen, MD, MPH; Patricia S. Keenan, PhD, MHS; Elizabeth E. Drye, MD, SM; Saif S. Rathore, MPH; Sharon-Lise T. Normand, PhD and Harlan M. Krumholz, MD, SM

From the Section of Cardiovascular Medicine (G.K.M.), Yale University School of Medicine, New Haven, Conn; Center for Outcomes Research and Evaluation (Y.W., Z.L., H.M.K.), Yale-New Haven Hospital, New Haven, Conn; the Section of Cardiovascular Medicine, Department of Internal Medicine (Y.W., O.J.W., J.C., E.E.D., H.M.K.), the Section of Health Policy and Administration, School of Public Health (P.S.K., H.M.K.), the Department of Internal Medicine (S.S.R.), and the Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale University School of Medicine, New Haven, Conn; and the Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health (S.-L.T.N.), Boston, Mass. G.K. Mulvey is currently with the University of Connecticut School of Medicine, Farmington, Conn.

Correspondence to Dr Krumholz, 1 Church St, Suite 200, New Haven, CT 06510. E-mail harlan.krumholz{at}yale.edu

Received October 6, 2008; accepted July 2, 2009.

Background— The rankings of "America’s Best Hospitals" by U.S. News & World Report are influential, but the performance of ranked hospitals in caring for patients with routine cardiac conditions such as heart failure is not known.

Methods and Results— Using hierarchical regression models based on medical administrative data from the period July 1, 2005, to June 30, 2006, we calculated risk-standardized mortality rates and risk-standardized readmission rates for ranked and nonranked hospitals in the treatment of heart failure. The mortality analysis examined 14 813 patients in 50 ranked hospitals and 409 806 patients in 4761 nonranked hospitals. The readmission analysis included 16 641 patients in 50 ranked hospitals and 458 473 patients in 4627 nonranked hospitals. Mean 30-day risk-standardized mortality rates were lower in ranked versus nonranked hospitals (10.1% versus 11.2%, P<0.01), whereas mean 30-day risk-standardized readmission rates were no different between ranked and nonranked hospitals (23.6% versus 23.8%, P=0.40). The 30-day risk-standardized mortality rates varied widely for both ranked and nonranked hospitals, ranging from 7.9% to 12.4% for ranked hospitals and from 7.1% to 17.5% for nonranked hospitals. The 30-day risk-standardized readmission rates also spanned a large range, from 18.7% to 29.3% for ranked hospitals and from 19.2% to 29.8% for nonranked hospitals.

Conclusions— Hospitals ranked by U.S. News & World Report as "America’s Best Hospitals" in "Heart & Heart Surgery" are more likely than nonranked hospitals to have a significantly lower than expected 30-day mortality rate, but there was much overlap in performance. For readmission, the rates were similar in ranked and nonranked hospitals.

Key Words: quality of health care • heart failure • hospitals

Guest Editor for this article was Veronique L. Roger, MD, MPH.