Bumetanide is associated with Lower Hospital Readmission Rates for Heart Failure Patients at AdventHealth Orlando based on Real World Evidence Study of Medicare Claims Data


In Bumetanide, Heart Failure

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By: Sara Riascos  May. 16, 2022

Background:

Heart Failure is frequently associated with hospital readmission. Readmission is a hospital quality measure that reflects dimensions of quality of inpatient care and also impacts overall programs by payors such as CMS’s Star Rating Program, HRRP and Value-Based Purchasing. Bumetanide is a diuretic that reduces extra fluid in the body (edema) caused by conditions such as heart failure, liver disease, and kidney disease. Studies have shown that when compared to similar drugs, a greater response was seen in patients treated with Bumetanide for heart failure.

Dexur’s analysis of Real World Evidence based on Medicare Claims data showed that the use of Bumetanide within 7 days of hospitalization was associated with lower hospital readmission rates for Heart Failure Patients at AdventHealth Orlando in Orlando, Florida. Reduction in readmission rates helps hospitals improve their outcomes for various cost and quality programs. Dexur is an approved entity to perform Medicare claims data analysis, which it uses to perform quality outcomes analysis. Dexur has published several papers with Harvard Medical School on quality outcomes related topics. Dexur’s analysis of drugs and their impact on quality outcomes, such as readmissions and mortality, are used by Hospitals, IDNs, and ACOs to implement best practices and manage Real World Evidence based risk factors.

Methods:

We conducted a retrospective study using Dexur’s analysis of Real World Evidence from Medicare Claims data, for hospitalizations at AdventHealth Orlando between January 2017 to September 2019. Our methodology criteria was as follows:

  1. Inclusion Criteria: Selected Medical Hospitalizations with Primary Diagnosis with Heart Failure related codes (Listed in table below)
  2. Stratified Selected population into cohorts
    1. Heart Failure patients who dispensed Bumetanide within 7 Days of Hospitalization using Part D drugs claims database
    2. Heart Failure patients who did not dispense Bumetanide within 7 Days of Hospitalization
  3. 30 Day readmission rates were analyzed for both population cohorts

Results:

Overall, Bumetanide was associated with lower hospital readmission rates for all Primary DRG Diagnosis Codes examined at AdventHealth Orlando. For patients whose primary DRG Diagnosis was “Heart Failure And Shock With Major Complication Or Comorbidity (MCC)”(291) and when Bumetanide was used within 7 days of hospitalization, the readmission rate was 21.31% compared to the cohort where Bumetanide was not used, whose readmission rate was 30.60%. The readmission odds ratio for these cohorts was 0.61. The use of Bumetanide was associated with a 39% lower readmission rate when used within 7 days of hospitalization. The full list of studied DRG codes, readmission rates, odds ratios, confidence intervals, and percentage reduction in readmission with Bumetanide at AdventHealth Orlando is shown below.


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Primary DRG Diagnosis Code Primary DRG Diagnosis Code Description Total Hospitalizations without Bumetanide Readmission Without Bumetanide Readmission Rate without Bumetanide Total Hospitalizations with Bumetanide Readmission with Bumetanide Readmission Rate with Bumetanide Readmission Odds Ratio Reduction in Readmission with Bumetanide (%) Confidence Interval (-) Confidence Intervals (+)
291 Heart Failure And Shock With Major Complication Or Comorbidity (MCC) 4,088

Dexur also leveraged Medicare claims data to understand what percentage of patients hospitalized with Heart Failure were not prescribed Bumetanide within 7 days of discharge.

DRG CODE Hospital Hospitalizations with Heart Failure % of Hospitalizations without Bumetanide
291 AdventHealth Orlando 4,101 99.68%
Methodist University Hospital 2,549 98.23%
Vidant Medical Center 2,484 99.44%

​Hospitalizations with Heart Failure = Above Listed DRG Codes

If figures are shared with “At Least” - this implies that the drug utilization within 7 days post hospitalization is less than 11

Conclusions:

According to analysis of Real World Evidence of Medicare Claims data, for hospitalizations between January 2017 to September 2019, the use of Bumetanide within 7 days of hospitalization can lead to substantial reductions in hospital readmission rates of Heart Failure patients at AdventHealth Orlando. This analysis shows that a significant number of patients are not dispensed Bumetanide after Heart Failure hospitalizations at AdventHealth Orlando or major US Hospitals.