Background: While depressed left ventricular ejection fraction is clearly associated with poor long-term outcome in heart failure (m, the effect of ejection fraction on short-term outcomes and resource utilization following hospitalization for HF remains unclear.
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Hypothesis:We evaluated the independent effect of depressed ejection fraction (I 40%) on short-term outcomes and resource utilization following hospitalization for HF.Methods: The study population included 443 consecutive patients hospitalized for DRG 127 (HF and shock) with known ejection fraction. For each patient, we assessed the hospitalization cost (1995 US$), length of stay, in-hospital mortality, 30-day mortality, and 30-day readmission rates. Results: Despite similar disease severity at admission, patients with ejection fraction 540% (Group l) had longer length of stay (4.0 vs. 3.7 days; p = 0.03), a tendency toward higher hospitalization cost ($3,054 vs. $2,770; p = 0.08), more readmissions for any cause (0.4 vs. 0.3; p = 0.05) and for HF (0.2 vs. 0.1; p = O.Ol), but similar in-hospital (2.5 vs. 2.6%) and 30-day mortality (4.0 vs. 4.6%) compared with patients with ejection fraction >40% (Group 2). In multivariate analyses, Group 1 patients were more likely to have higher than median hospitalization cost [odds ratio (OR) = 1.98; 95% confidence intervals (CI) = 1.02-3.911 and longer than median hospital stay (OR = 1.68; CI=1.08-3.91); they were also more likely to be readmitted for any cause (OR = 2.07; CI = 1.15-3.78) orforHF(OR=5.71; CI= 1.64-21.94),andthey tended to have a higher 30-day incidence of death or readmission (OR = 1.65; CI = 0.96-2.84).
Conclusions:Depressed left ventricular ejection fraction is associated with higher resource utilization and readmission rates following hospitalization for HF. Greater focus on patients with depressed ejection fraction may increase cost savings from HF disease management programs.
SummaryBackground: It is suspected that effective therapies are often underutilized in black compared with white patients with coronary artery disease (CAD).Hypothesis: We hypothesized that an unfavorable bias may exist against black patients in the medical management of heart failure.Methods: In 566 consecutive adult subjects who were discharged alive from the hospital with a principal discharge diagnosis of heart failure, we assessed the effect of patient race on utilization of classes of medications (angiotensin-converting enzyme inhibitors [ACEI], digitalis, diuretic agents) and combinations of medications (effective vasodilators, i.e., ACEI or combined hydralazine and nitrate; effective combination therapy, i.e., effective vasodilator with digitalis and diuretic) known to be beneficial in symptomatic heart failure.Results: Compared with black patients (n = 182), white patients were older, had a higher incidence of coronary artery disease, lower incidence of hypertension, and lower serum creatinine and left ventricular end-diastolic diameter. In crude analyses, the utilization of all medications was similar between white and black patients. After adjustment for clinical differences, black patients were more likely to receive ACEI (adjusted odds ratio [OR] = 1.84; 95% confidence interval [CI] 1.13-3.01), effective vasodilators (OR = 1.97; CI 1.20-3.23), and effective combination therapy (OR = 1.66; CI
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