Does Hospital Ownership Affect What Happens After a Heart Attack?

If you have a heart attack, you probably aren’t thinking about whether the hospital is for-profit or nonprofit.

You’re thinking about one thing:

Am I going to be okay?

But a new study published in JACC: Advances raises an interesting question about what happens after the initial heart attack hospitalization.

Researchers analyzing more than 4.6 million heart attack admissions in the United States found that 30-day unplanned readmission rates declined at nonprofit hospitals between 2013 and 2022, while they remained relatively stable at for-profit hospitals.

That sounds like a straightforward finding.

It isn’t.

The study does not show that for-profit hospitals provide worse heart-attack care overall. In fact, mortality was similar among patients readmitted to the two types of hospitals, and some complications were actually less common at for-profit facilities.

So what did the researchers actually discover?

The researchers looked at 4.6 million heart attacks

The UCLA research team analyzed data from the Agency for Healthcare Research and Quality’s Nationwide Readmissions Database covering 2013 through 2022.

The study included adults hospitalized for acute myocardial infarction — the medical term for a heart attack — including both STEMI and NSTEMI heart attacks.

There were an estimated 4,636,970 heart-attack admissions in the analysis.

Of those, 534,576 — 11.5% — resulted in an unplanned readmission within 30 days.

The researchers compared hospitals according to ownership:

• For-profit hospitals
• Not-for-profit hospitals

This was an observational study based on hospital administrative data. That distinction matters because the study can identify associations, but it cannot prove that hospital ownership itself caused the differences.

The big finding: readmissions moved in different directions

At nonprofit hospitals, the 30-day readmission rate fell from:

11.5% in 2013 → 10.5% in 2022

That decline was statistically significant.

At for-profit hospitals, the rate went from:

13.0% in 2013 → 12.7% in 2022

The researchers did not find a statistically significant downward trend at for-profit hospitals.

The pattern was also seen among patients undergoing PCI — angioplasty and stenting.

At nonprofit hospitals, readmissions following PCI declined from 8.8% to 7.9%.

At for-profit hospitals, they remained relatively stable, moving from 10.3% to 10.0%.

But there was an important exception.

Among patients undergoing coronary artery bypass surgery (CABG), readmissions declined at both types of hospitals:

• Nonprofit: 12.2% → 10.0%
• For-profit: 14.3% → 13.1%

So this isn’t simply a story of one type of hospital improving while the other doesn’t. The pattern depended partly on the treatment patients received.

For-profit hospitals didn’t have higher mortality

Here’s where the story gets more interesting.

You might assume that higher readmission rates would mean patients were also more likely to die.

The study didn’t find that.

Among patients who were readmitted, the risk-adjusted odds of dying in the hospital were similar between for-profit and nonprofit hospitals.

The adjusted odds ratio was 0.97, with a 95% confidence interval of 0.91–1.02.

For the initial heart-attack hospitalization, in-hospital mortality was actually slightly lower at for-profit hospitals:

6.26% vs. 6.53%

But that does not mean for-profit hospitals were safer overall.

Why?

Because the database doesn’t capture deaths that occur outside the hospital after discharge.

That is a major limitation. Someone who dies at home cannot subsequently be readmitted, so readmission statistics alone cannot provide a complete picture of survival after a heart attack.

Some complications went in different directions

The researchers also examined complications among patients who were readmitted to the same hospital.

After statistical adjustment, for-profit hospitals were associated with:

• Lower odds of cardiac complications
• Lower odds of blood transfusion
• Higher odds of respiratory complications
• Higher odds of renal complications
• Higher odds of discharge somewhere other than home

For example, the adjusted odds of respiratory complications were 11% higher, while renal complications were about 4% higher.

On the other hand, the adjusted odds of cardiac complications were about 8% lower, and the odds of blood transfusion were about 15% lower.

So once again, the data don’t support a simple:

For-profit = bad care

conclusion.

The reality is considerably more complicated.

Why might readmissions differ?

This is where we need to be especially careful.

The study found an association between hospital ownership and readmission, but it did not establish why the difference exists.

The researchers discuss several possible explanations.

One involves discharge planning and follow-up care.

A patient can receive excellent treatment for the heart attack itself and still end up back in the hospital if medication management, follow-up appointments, rehabilitation, or coordination between the hospital and outpatient doctors doesn’t go smoothly.

The authors specifically say future research should examine whether differences in discharge-planning infrastructure and post-hospital care coordination help explain the differences.

There were also meaningful differences between the patient populations and hospitals.

For-profit hospitals treated a greater proportion of patients from the lowest income quartile, and their patients were more often treated at metropolitan nonteaching hospitals with somewhat lower annual heart-attack volumes.

The researchers used statistical methods to adjust for many differences.

But no observational study can completely eliminate the possibility that other, unmeasured factors contributed to the findings.

The Medicare finding is particularly interesting

The researchers found something else that deserves attention.

Among Medicare beneficiaries, readmission rates declined at both types of hospitals.

At nonprofit hospitals:

14.2% → 12.8%

At for-profit hospitals:

15.7% → 15.0%

Why might Medicare patients be different?

One possible explanation is the Hospital Readmissions Reduction Program (HRRP).

The program, introduced in 2012, financially penalizes hospitals for higher-than-expected 30-day readmission rates for certain conditions, including heart attacks.

Those penalties specifically apply to Medicare fee-for-service patients.

The researchers suggest that this financial incentive could help explain why Medicare readmissions declined at both types of hospitals.

That’s a plausible explanation — but it remains a hypothesis rather than something this study proves.

For-profit hospitals also had lower hospital expenditures

There was another notable finding.

After adjustment, for-profit status was associated with approximately:

$4,298 lower expenditures during the initial hospitalization

and

$2,753 lower expenditures during readmission.

At the same time, patients at for-profit hospitals had a slightly longer adjusted readmission stay and were somewhat more likely to have a nonhome discharge.

But lower spending doesn’t automatically mean better or worse care.

Hospital costs can reflect many things — patient characteristics, hospital structure, local costs, treatment patterns and resource use.

So should you avoid for-profit hospitals?

The study doesn’t answer that question.

And if you’re having a heart attack, you should not delay emergency treatment while trying to determine whether the nearest hospital is nonprofit or for-profit.

Call 911 and get medical care immediately.

Hospital ownership is only one characteristic of a hospital.

Other factors can matter enormously, including whether the hospital has a cardiac catheterization laboratory, how quickly it can perform PCI, the experience of its cardiac team, staffing, cardiac rehabilitation, discharge planning and the quality of follow-up care.

What this study shows is that hospital ownership was associated with different patterns of 30-day readmission and certain complications in a very large national dataset. It does not establish that one ownership model provides better overall heart-attack care.

The part patients can actually use

Here’s the part of this study that may be more useful to you than the ownership question.

If you’ve had a heart attack, leaving the hospital isn’t the end of treatment.

It’s the beginning of another phase.

Before you go home, make sure you understand:

What medications am I supposed to take?

What symptoms should make me call for help?

When is my follow-up appointment?

Am I a candidate for cardiac rehabilitation?

Who should I call if I have a problem with one of my medications?

What should I do if I develop chest pain or shortness of breath?

And there’s one more question worth asking:

Does someone at home understand the plan too?

Those questions may matter much more to an individual patient than whether the hospital happens to be for-profit or nonprofit.

The bigger lesson

It’s tempting to judge a hospital using one number.

Readmission rate.

Mortality rate.

Cost.

But healthcare quality is rarely that simple.

This study is a good example.

For-profit hospitals had higher adjusted odds of 30-day readmission and some complications. But mortality during readmission was similar, cardiac complications were less common, and blood transfusions were less common.

And because this was an observational study, we can’t say that ownership itself caused those differences.

What the research does suggest is that what happens after a heart attack deserves more attention.

The initial treatment is obviously critical.

But recovery continues after discharge — through medications, follow-up, cardiac rehabilitation, lifestyle changes and coordination between the hospital and the patient’s regular healthcare team.

The Senior Life Watchdog takeaway

This study gives us a fascinating look at American heart-attack care.

From 2013 to 2022, 30-day unplanned heart-attack readmissions declined significantly at nonprofit hospitals but remained relatively stable at for-profit hospitals overall.

After adjustment, for-profit hospital status was associated with higher odds of readmission, respiratory and renal complications, and nonhome discharge. But mortality during readmission was similar, and some complications were actually less common.

So the takeaway isn’t:

“Don’t go to a for-profit hospital.”

It’s more useful than that.

Don’t assume that getting through the heart attack is the whole story.

If you or someone you love is hospitalized with a heart attack, pay attention to what happens after the artery is opened:

What medications are prescribed?

What follow-up is arranged?

Is cardiac rehabilitation offered?

Who coordinates the transition home?

And what happens if something goes wrong?

Because surviving a heart attack is one thing.

Recovering well from one is another.