Furosemide is associated with Lower Hospital Readmission Rates for Heart Failure Patients at Memorial Hermann Southwest Hospital based on Real World Evidence Study of Medicare Claims Data

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In Furosemide, Heart Failure

By: Sara Riascos  Mar. 02, 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 payers such as CMS’s Star Rating Program, HRRP and Value-Based Purchasing. Furosemide is a loop diuretic medication used to treat fluid build-up due to heart failure, liver scarring, or kidney disease. Studies have shown that the early use of Furosemide was associated with lower mortality for heart Failure Patients.

Dexur’s analysis of Real-World Evidence based on Medicare Claims data showed that the use of Furosemide within 7 days of hospitalization was associated with lower hospital readmission rates for Heart Failure Patients at Memorial Hermann Southwest Hospital in Houston, Texas. 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 Memorial Hermann Southwest Hospital 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 Furosemide within 7 Days of Hospitalization using Part D drugs claims database
   2. Heart Failure patients who did not dispense Furosemide within 7 Days of Hospitalization
3. 30 Day readmission rates were analyzed for both population cohorts

Results:

Overall, Furosemide was associated with lower hospital readmission rates for all Primary DRG Diagnosis Codes examined at Memorial Hermann Southwest Hospital. For patients whose primary DRG Diagnosis was “Heart Failure and Shock With Major Complication or Comorbidity (MCC)” (291) and when Furosemide was used within 7 days of hospitalization, the readmission rate was 22.99% compared to the cohort where Furosemide was not used, whose readmission rate was 30.74%. The readmission odds ratio for these cohorts was 0.68. The use of Furosemide was associated with a 32% 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 Furosemide at Memorial Hermann Southwest Hospital is shown below.

Primary DRG Diagnosis Code	Primary DRG Diagnosis Code Description	Total Hospitalizations without Furosemide	Readmission Without Furosemide	Readmission Rate without Furosemide	Total Hospitalizations with Furosemide	Readmission with Furosemide	Readmission Rate with Furosemide	Readmission Odds Ratio	Reduction in Readmission with Furosemide(%)	Confidence Interval (-)	Confidence Intervals (+)
291	Heart Failure And Shock With Major Complication Or Comorbidity (MCC)	2,085

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

DRG CODE	Hospital	Hospitalizations with Heart Failure	% of Hospitalizations without Furosemide
291	Florida Hospital	4,101	99.6%
	Methodist University Hospital	2,549	98.23%
	Memorial Hermann Southwest Hospital	2,128	97.97%

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Conclusions:

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