3.3 Ten-year trends for heart failure outcomes 165 Trends for readmission and mortality A 17.8% increase in overall readmissions from 16.6% in 2007-2008 to 19.6% in 2015 was observed and this trend remained significant at +2% per calendar year after adjusting for age, sex and ethnicity (p trend <0.001). Figure 1(a) shows that agestandardised trends for 30-day readmission in men were proportionally higher than the rate for women. Although Others had the lowest readmission rates in 2007, its rise with time was the largest compared to the other ethnic groups (Figure 2 (a)). The mean number of hospitalisations per patient within a year has risen slightly from 1.3 in 2007 to 1.6 in 2015 and a modest increase of 0.04 per calendar year was still evident after accounting for age, sex and ethnicity (p trend<0.001). Overall, in-hospital mortality rates nearly halved from 6.9% (95% CI 6.6 -7.3) in 2007 to 3.7% (95% CI 3.5 -3.9) in 2016 with similar trends for men and women (Figure 1(b)). This declining trend remained after adjustment for age, sex and ethnicity (average -7% per year; p trend <0.001). Improvements in mortality were also evident within 30 days of hospitalisation, seen as a 26% decline from 13.1% (95% CI 12.6 -13.6%) in 2007 to 9.7% (95% CI 9.3 -10.1%) in 2016. Men had consistently higher 30-day mortality rates than women during the study period (Figure 1(c)). Upon full-model adjustment, the average improvement in 30-day mortality was 4% per calendar year (p trend<0.001). By contrast, all-cause mortality in one year remained unchanged throughout the study period (p trend =0.113) with men having almost uniformly higher rates than women (Figure 1(d)). Despite poorer overall outcomes, Others showed the most pronounced improvements in short-term mortality over time compared to other groups (Figure 2 (b) and (c)). The rates for 30-day mortality between Others and Malays narrowed from 6.2% in 2007 to 3.5% in absolute rate difference in 2016 but this difference was not significant after full model adjustment (p interaction=0.091; Supplementary table 2). With respect to 1-year mortality, only Others showed significant average decline by 1% per year (p interaction =0.021) relative to Malays (Figure 2 (d), Supplementary table2). Cause of readmission and death Cardiovascular causes accounted for half of all 30-day readmissions (50.1%) (Figure 3) with HF specifically accounting for 27.7%. Analysis on all medically-certified
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