By: James Pitt  Jun. 13, 2018
Coronary artery disease is a condition in which plaque reduces blood flow through arteries to the heart. One of the most common treatments is coronary artery bypass grafting (CABG). This is a surgical procedure in which healthy blood vessels are grafted onto the heart to provide an alternate route for blood to flow, bypassing the occluded arteries.
Heart failure with reduced ejection fraction (HFrEF, aka reduced LVEF) is an important predictor of outcomes after CABG. According to a 2016 American Heart Association science advisory, patients with left ventricular ejection fraction under 0.35 have higher mortality after CABG than patients with preserved LVEF. Fortunately, “up to 50% of patients will demonstrate significant improvement in LVEF after CABG.”
Following Dexur's examination of percutaneous coronary intervention in Massachusetts, analysts examined CABG at Massachusetts hospitals with over 10,000 CMS inpatient discharges per year. At these hospitals, between 1.81% and 3.41% of patients discharged with CABG were readmitted with HFrEF within 30 days. The lowest HFrEF readmission rate was at Beth Israel Deaconess Medical Center (Boston, MA), and the highest at Baystate Medical Center (Springfield, MA).
HFrEF did not closely correspond to all-cause 30 day readmissions. This may present an opportunity to target HFrEF readmissions specifically, rather than as part of a larger CABG-readmissions-reduction initiative.
HFrEF was a substantial contributor to all-cause 30-day readmissions after CABG. HFrEF was involved in at least 7% of all-cause 30 day readmissions (at Beth Israel Deaconess), and as high as 17% of all-cause 30 day readmissions (at Baystate Medical Center).
Because patients with reduced ejection fraction are at higher risk of mortality after CABG, tracking patients whose ejection fraction has not improved after CABG may present an opportunity to reduce overall 30-day readmission rates among CABG patients.
For coronary artery bypass grafting (includes DRG 231, DRG 232, DRG 233, DRG 234, DRG 235, and DRG 236) from 2013-2016.
Hospitals mentioned in this article: