Torsemide is associated with lower hospital readmission rates for heart failure patients at St Anthony’s Medical Center based on a real-world evidence review of Medicare claims data


In Torsemide, heart failure



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By: Sara Riascos Mar 09, 2022

Context:

Heart failure is frequently associated with readmission to hospital. Readmission is a measure of hospital quality that reflects dimensions of inpatient care quality and also impacts global payer programs such as the CMS Star Rating Program, HRRP and value-based purchases. 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 the severity of heart failure. Other studies have shown that torsemide may be superior 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 Torsemide use within 7 days of hospitalization was associated with lower hospital readmission rates for patients suffering from heart failure at St Anthony’s Medical Center in St Louis, Missouri. Reducing readmission rates helps hospitals improve their outcomes for various cost and quality programs. Dexur is an entity licensed to perform Medicare claims data analysis, which it uses to perform quality outcome analysis. Dexur has published several articles with Harvard Medical School on topics related to quality outcomes. Dexur’s analysis of medications and their impact on quality outcomes, such as readmissions and mortality, is used by hospitals, IDNs and ACOs to implement best practices and manage risk factors based on real-world evidence.

Methods :

We conducted a retrospective study using Dexur’s analysis of real-world Medicare claims data, for hospitalizations at St Anthony’s Medical Center between January 2017 and September 2019. Our methodological criteria were as follows: :

  1. Inclusion criteria: selected medical hospitalizations with primary diagnosis and codes related to heart failure (listed in the table below)
  2. Selected population stratified into cohorts
    1. Patients with heart failure who dispensed Torsemide within 7 days of hospitalization using the Part D Drug Claims Database
    2. Patients with heart failure who have not received 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 St Anthony’s Medical Center. 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 24.56% compared to the cohort where Torsemide was not used, whose readmission rate was 27.27%. The readmission odds ratio for these cohorts was 0.87. Torsemide use was associated with a 13% 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 readmissions with Torsemide at St Anthony’s Medical Center is shown below.

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Dexur also leveraged Medicare claims data to understand what percentage of hospitalized heart failure patients did not receive a prescription for Torsemide within 7 days of discharge.







DRG CODE Hospital Hospitalizations with heart failure % of hospitalizations without Torsemide
291 Mayo Clinic Hospital-Rochester, ROCHESTER, MN, 55902 1,400 99.15%
St Anthony’s Medical Center 1,305 98.93%
Cleveland Clinic 1,229 99.02%

​Hospitalizations with heart failure = DRG codes listed above

If the figures are shared with “At least” – it implies that the use of drugs within 7 days of hospitalization is less than 11

Conclusion:

According to analysis of actual evidence data from health insurance claims, for hospitalizations between January January 2017 and September 2019, use of Torsemide within 7 days of hospitalization may result in substantial reductions in rates of hospital readmission of patients with heart failure at St Anthony’s Medical Center . This analysis shows that a significant number of patients do not receive Torsemide after heart failure hospitalizations at St Anthony’s Medical Center or major US hospitals.