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Background

Heart failure patients tend to experience higher rates of hospital readmissions compared to other ambulatory care-sensitive conditions. In Sweden, the nationwide Care Coordination Act (CCA) was introduced in January 2018 with the goal of improving care coordination resulting in a reduction of readmissions and length of stay. There is insufficient knowledge regarding the effect of this reform on heart failure patients.

Methods

We studied the association of implementing CCA on all cause 30-day readmissions and length of stay for patients over 65 years of age with ICD-50 heart failure. The dataset included all admissions with a primary diagnosis of heart failure among elderly, multimorbid patients between 2015 and 2019. An interrupted time series analysis using hierarchical mixed models with random effects clustered at the hospital ward level was conducted.

Results

A total of 111 414 admissions were included. The average readmission rate for heart failure patients was 26.8 % before and 26.7 % after the CCA. The average length of stay (LOS) was 8.4 days before the CCA and 8.1 days after. Mortality within 30 days was 7.3 % before the CCA and 7.5 % after. There were no significant differences between the periods before and after. In an analysis assessing the overall linear time trend 2 of 21 regions showed a reduction in readmissions and 10 in length of stay.

Conclusions

After the introducing the CCA, no detectable impact was found on readmissions or mortality for heart failure patients, which is in line with previous studies such as those studying the US Hospital Readmission Reduction Program. While no overall association on length of stay could be identified, it was reduced in a number of the Swedish regions. The heterogeneity between regions could be used to understand the specific components needed to achieve reduction of readmissions in future studies.