Long-term trends of use of health service among heart failure patients

Abstract

Chronic high-impact users constitute a small proportion of total patients, but they have increasingly high use of healthcare services. Short-term high-impact users represent largely end of life patients. They require prompt involvement of the palliative care team to reduce unnecessary readmissions to hospital.

Reply in response to ‘Defining a “frequent admitter” phenotype among patients with repeat heart failure admissions’

“…Nonetheless, recurrent HF hospitalization is also an important, relevant and treatable outcome measure for both HF trials [3][4][5] and clinical practice. We also agree that the care needs of patients at different time-points in their disease trajectories may differ, and appreciate the complementary information provided by the comprehensive analyses of Rao et al 2 that inform health service delivery in the UK. Together our papers bring us closer to achieving our shared goals of identifying patients at risk of frequent hospitalization in order to offer more intensive care to prevent hospitalizations where possible, and to improve patient outcomes as well as health service delivery.…”

“…We too have read with interest Dr Bottle's prior paper characterizing UK patients with heart failure (HF) into five meaningful readmission trajectories, enabling the identification of ‘high‐impact’ users and their predictors. The common use of trajectory analysis in both the prior and current papers suggests that we agree on the basic premise that patients with frequent HF hospitalizations can be profiled and segregated. Building on this basic premise, the intents and purposes of the two analyses differ in their emphasis: Rao et al .…”

“…emphasized readmittance trajectory type identification for the purposes of developing appropriate health services for high‐impact users, whereas we focused on identifying high‐frequency readmittance with reliance on the subsequent clinical examination and patient history to target intensive HF treatment . Accordingly, Rao et al . identified five readmission trajectories and focused on the comprehensive descriptive characterization of patients with a high‐impact trajectory, but did not specifically provide a clinical risk assessment tool.…”

Letter in reference to “Defining a ‘frequent admitter’ phenotype among patients with repeat heart failure admissions”

“…Crucially, with this method we could distinguish between short-term and longterm frequent admitters. 4 We also benefitted from linked primary and secondary care data and showed large differences in patient outcomes and health service use between the groups.…”

“…Last year, in another European Society of Cardiology journal, we published our analysis of trajectory modelling on all‐cause admissions for patients with HF, over a 5‐year period. Crucially, with this method we could distinguish between short‐term and long‐term frequent admitters . We also benefitted from linked primary and secondary care data and showed large differences in patient outcomes and health service use between the groups.…”