Torsemide is associated with Lower Hospital Readmission Rates for Heart Failure Patients at Cleveland Clinic based on Real World Evidence Study of Medicare Claims Data

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In Torsemide, Heart Failure

By: Sara Riascos  Mar. 04, 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. Torsemide is a diuretic used to treat fluid overload due to heart failure, kidney disease, liver disease and high blood pressure. Studies have shown that patients treated with torasemide for up to 1 year decreased Heart Failure severity. Otherx studies have shown that torsemide may be superior compared to other drugs when it comes to reducing Heart Failure hospitalizations.

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

Results:

Overall, Torsemide was associated with lower hospital readmission rates for all Primary DRG Diagnosis Codes examined at Cleveland Clinic. For patients whose primary DRG Diagnosis was “Heart Failure And Shock With Major Complication Or Comorbidity (MCC)”(291) and when Torsemide was used within 7 days of hospitalization, the readmission rate was 24% compared to the cohort where Torsemide was not used, whose readmission rate was 28.35%. The readmission odds ratio for these cohorts was 0.80. The use of Torsemide was associated with a 20% 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 Torsemide at Cleveland Clinic is shown below.

Primary DRG Diagnosis Code	Primary DRG Diagnosis Code Description	Total Hospitalizations without Torsemide	Readmission Without Torsemide	Readmission Rate without Torsemide	Total Hospitalizations with Torsemide	Readmission with Torsemide	Readmission Rate with Torsemide	Readmission Odds Ratio	Reduction in Readmission with Torsemide (%)	Confidence Interval (-)	Confidence Intervals (+)
291	Heart Failure And Shock With Major Complication Or Comorbidity (MCC)	1,217

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

DRG CODE	Hospital	Hospitalizations with Heart Failure	% of Hospitalizations without Torsemide
I130	Eisenhower Medical Center	1,409	99.22%
	St Anthony's Medical Center	1,305	98.93%
	Cleveland Clinic	1,229	99.02%

​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 January 2017 to September 2019, the use of Torsemide within 7 days of hospitalization can lead to substantial reductions in hospital readmission rates of Heart Failure patients at Cleveland Clinic. This analysis shows that a significant number of Patients are not dispensed Torsemide after Heart Failure hospitalizations at Cleveland Clinic or major US Hospitals.