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The ACA Hospital Readmissions Reduction Program applies penalties for high readmission rates. Among Medicare beneficiaries, rates declined after the ACA went into effect. There was no significant association between changes in observation stays and readmissions. Hospital readmissions within 30 days after discharge have drawn national policy attention because they are very costly, accounting for more than $17 billion in avoidable Medicare expenditures, 1 and are associated with poor outcomes. In response to these concerns, the Affordable Care Act (ACA), which was passed in March 2010, created the Hospital Readmissions Reduction Program. Since October 2012, the start of fiscal year (FY) 2013, the program has penalized hospitals with higher-than-expected 30-day readmission rates for selected clinical conditions. In FY 2013 and 2014, these conditions were acute myocardial infarction, heart failure, and pneumonia. Total hip or knee replacement and . . .

Patients undergoing transcatheter aortic valve implantation (TAVI) are at increased risk of rehospitalization in the early period after discharge from TAVI. The HOSPITAVI study aimed to compare the impact of a standard versus intensified outpatient follow-up on rehospitalization rates within 90 days after TAVI discharge. Patients were 1:1 randomized to either a standard or intensified outpatient follow-up after TAVI discharge. The primary endpoint was the 90-day hospital rehospitalization rate. In total, 300 patients were included: 150 patients were randomized to standard follow-up and 150 patients to intensified outpatient follow-up. The study population had a median age of 79 years, a median EuroSCORE II of 2.9%, and 72% were discharged the day after TAVI. Within 90 days after discharge, the mean number of all-cause hospital readmissions per patient was 0.44 versus 0.35 (HR 0.8 [95% CI, 0.6–1.2], p = 0.23) in the standard versus intensified group, respectively. The mean number of cardiovascular (CV) readmissions per patient was 0.27 versus 0.15 (HR 0.6 [95% CI, 0.4–1.0], p = 0.04) in the standard versus intensified group, respectively. This resulted in a mean number of CV readmission days per patient of 1.52 days versus 0.49 days within the first 90 days in the standard versus intensified group, respectively (p < 0.05). Following TAVI discharge, there was no significant difference in all-cause rehospitalization rates using a standard versus intensified outpatient follow-up approach. However, an intensified outpatient follow-up reduces the burden of early CV rehospitalization after TAVI discharge. (Rehospitalization after transcatheter aortic valve implantation [HOSPITAVI]; NCT05670041). [Display omitted]

Older patients hospitalized for heart failure were randomly assigned to a rehabilitation intervention (which included multiple function domains) or control; the intervention began during, or early after, hospitalization and continued for 3 months. At 3 months, physical function, as assessed by the Short Physical Performance Battery, was better in the intervention group than in the control group.

In a randomized trial, 1000 patients with severe aortic stenosis who were at low risk for death with surgery were assigned to undergo transcatheter aortic-valve replacement with a balloon-expandable valve or surgical aortic-valve replacement. At 1 year, the rate of death, stroke, or rehospitalization was significantly lower in the TAVR group.

Nesiritide was approved by the FDA on the basis of small clinical trials for the treatment of acute heart failure. In this large clinical trial, nesiritide did not improve outcomes in patients with acute heart failure, and it can no longer be recommended for this condition. Acute decompensated heart failure is a major health problem that is associated with several million hospitalizations worldwide each year, poor short-term outcomes, and high costs. 1 – 3 Despite the magnitude of the problem, rates of early death and rehospitalization have not improved over the past several decades. 3 Nesiritide, a recombinant B-type natriuretic peptide (BNP) with vasodilatory properties, 4 – 7 was approved in 2001 for use in patients with acute heart failure on the basis of studies showing a reduction in pulmonary-capillary wedge pressure and improvement in dyspnea at 3 hours. 5 , 6 , 8 However, subsequent pooled analyses of data from small, randomized trials . . .

More than 250 patients with uncomplicated, primary spontaneous pneumothorax were treated conservatively or by pleural intervention. In a complete-case analysis, reexpansion within 8 weeks occurred in 98.5% of the patients in the intervention group and in 94.4% of those in the conservative-management group.

A Camden, New Jersey, “hotspotting” program is designed to prevent rehospitalizations among “superutilizers” of heath care services through home visits and telephone calls from nurses, social workers, and community health care workers who help coordinate outpatient care. In a randomized, controlled trial, the program did not reduce hospital readmissions.

Objective To investigate whether an early rehabilitation intervention initiated during acute admission for exacerbations of chronic respiratory disease reduces the risk of readmission over 12 months and ameliorates the negative effects of the episode on physical performance and health status.Design Prospective, randomised controlled trial.Setting An acute cardiorespiratory unit in a teaching hospital and an acute medical unit in an affiliated teaching district general hospital, United Kingdom.Participants 389 patients aged between 45 and 93 who within 48 hours of admission to hospital with an exacerbation of chronic respiratory disease were randomised to an early rehabilitation intervention (n=196) or to usual care (n=193).Main outcome measures The primary outcome was readmission rate at 12 months. Secondary outcomes included number of hospital days, mortality, physical performance, and health status. The primary analysis was by intention to treat, with prespecified per protocol analysis as a secondary outcome.Interventions Participants in the early rehabilitation group received a six week intervention, started within 48 hours of admission. The intervention comprised prescribed, progressive aerobic, resistance, and neuromuscular electrical stimulation training. Patients also received a self management and education package.Results Of the 389 participants, 320 (82%) had a primary diagnosis of chronic obstructive pulmonary disease. 233 (60%) were readmitted at least once in the following year (62% in the intervention group and 58% in the control group). No significant difference between groups was found (hazard ratio 1.1, 95% confidence interval 0.86 to 1.43, P=0.4). An increase in mortality was seen in the intervention group at one year (odds ratio 1.74, 95% confidence interval 1.05 to 2.88, P=0.03). Significant recovery in physical performance and health status was seen after discharge in both groups, with no significant difference between groups at one year.Conclusion Early rehabilitation during hospital admission for chronic respiratory disease did not reduce the risk of subsequent readmission or enhance recovery of physical function following the event over 12 months. Mortality at 12 months was higher in the intervention group. The results suggest that beyond current standard physiotherapy practice, progressive exercise rehabilitation should not be started during the early stages of the acute illness.Trial registration Current Controlled Trials ISRCTN05557928.

After 2 years of follow-up in a randomized trial involving 301 patients with moderate ischemic mitral regurgitation undergoing CABG, the addition of mitral-valve repair did not improve left ventricular function or remodeling. Ischemic mitral regurgitation of moderate severity develops in approximately 10% of patients after myocardial infarction. 1 , 2 Mitral regurgitation is caused by the displacement of papillary muscle, leaflet tethering, reduced closing forces, and annular dilatation. Over time, the condition has an adverse effect on the rate of survival free of heart failure. 3 Because most patients with ischemic mitral regurgitation have multivessel coronary artery disease requiring revascularization, surgeons have to consider whether to add mitral-valve repair to coronary-artery bypass grafting (CABG). The appropriate surgical management of moderate ischemic mitral regurgitation at the time of CABG remains controversial. Some experts advocate revascularization alone . . .

Patients with heart failure, coronary artery disease, and no atrial fibrillation were randomly assigned to receive 2.5 mg of rivaroxaban twice daily or placebo. Rivaroxaban did not have a significant effect on the composite outcome of death, myocardial infarction, or stroke.