# Explaining Rising Heart Failure Mortality in Medicare

> **NIH NIH K23** · BETH ISRAEL DEACONESS MEDICAL CENTER · 2022 · $172,527

## Abstract

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PROJECT(SUMMARY/ABSTRACT(
The clinical and financial burden of heart failure (HF) among older adults in the United States is high, with over
400,000 hospitalizations and $30 billion in spending annually. After a decade of steady improvement in short-
term mortality among older adults hospitalized with HF, mortality within 30 days of hospital discharge is now
increasing in this population. Little is known, however, about the factors driving this concerning trend. This
study proposes to use administrative and qualitative data to evaluate patient, hospital, and policy level factors
that explain rising mortality. In Aim 1, we will use Medicare data to determine if increasing clinical and/or social
risk among older adults hospitalized with HF, or worsening hospital care quality, explain recent trends in
mortality. In Aim 2, we will examine whether the Hospital Readmissions Reduction Program (HRRP) - a federal
policy that intended to improve HF care by financially penalizing hospitals with high 30-day readmission rates –
has incentivized inappropriate post-discharge care strategies (i.e. avoiding indicated readmissions) that have
been associated with increased mortality. Our preliminary data suggest that the rise in mortality is being driven
by patients with HF who are not readmitted to the hospital, providing initial support for this hypothesis. In Aim
3, we will use semi-structured physician interviews to understand if their decision-making regarding the care of
HF patients has changed since HRRP. In addition, we will interview patients with HF to explore their
awareness and perception of this policy. These interviews will also be used to gather preliminary data on
potential strategies to improve post-discharge HF care. The overarching goal of this proposal is to understand
why short-term mortality among older adults with HF is rising in the United States, which may have significant
clinical and policy implications. The first two aims of this analysis will inform whether more resources should be
allocated to sites that care for clinically high-risk or socially disadvantaged populations and if current federal
policies (HRRP) should be redesigned or eliminated. The third aim will lay the foundation for future research to
develop and test novel strategies, based on physician and patient preferences, to improve post-discharge HF
care. This research will be accomplished in the setting of a comprehensive career development program
designed to provide Dr. Wadhera, an early career investigator and cardiologist, with the skills needed to
become an independent investigator in cardiovascular medicine and health policy. His long-term career goal is
to use large datasets at the population level, and qualitative methods at the individual level, to
comprehensively evaluate the impact of health policies on cardiovascular care and outcomes. An outstanding
mentoring team and advisory committee of established clinical investigators in the fields of cardiovascular
m...

## Key facts

- **NIH application ID:** 10437732
- **Project number:** 5K23HL148525-04
- **Recipient organization:** BETH ISRAEL DEACONESS MEDICAL CENTER
- **Principal Investigator:** Rishi Kumar Wadhera
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $172,527
- **Award type:** 5
- **Project period:** 2019-07-15 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10437732

## Citation

> US National Institutes of Health, RePORTER application 10437732, Explaining Rising Heart Failure Mortality in Medicare (5K23HL148525-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10437732. Licensed CC0.

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