Outpatient versus inpatient worsening heart failure: distinguishing biology and risk from location of care

Greene, Stephen J.; Felker, G. Michael; Butler, Javed

doi:10.1002/ejhf.1341

Cited by 12 publications

(8 citation statements)

References 18 publications

(28 reference statements)

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“…a strategy of care that has not changed over time. 23 Still, the risk of hospitalization for HF in Denmark was low compared with the risk of HF hospitalization in the rest of Europe and the USA. 24 , 25 Nevertheless, inpatients had higher absolute risks of HF rehospitalization compared with the risk of having a first HF hospitalization as an outpatient during days 31–1826 (5 years) of follow-up—supporting the concept that inpatients are sicker, frailer, and potentially have more severe HF.…”

Section: Discussionmentioning

confidence: 96%

Importance of diagnostic setting in determining mortality in patients with new-onset heart failure: temporal trends in Denmark from 1997 to 2017

Arulmurugananthavadivel

Holt

Parveen

et al. 2021

European Heart Journal - Quality of Care and Clinical Outcomes

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Aim To investigate temporal trends in in-patient versus out-patient diagnosis of new-onset heart failure (HF) and the subsequent risk of death and hospitalization. Methods and results Using nationwide registers, 192,581 patients with a first diagnosis of HF (1997–2017) were included. We computed incidences of HF, age-standardized mortality rates, and absolute risks (AR) of death and hospitalization (accounting for competing risk of death) to understand the importance of the diagnosis setting in relation to subsequent mortality and hospitalization. The overall incidence of HF was approximately the same (170/100,000 persons) every year during 1997–2017. However, in 1997, 77% of all first diagnoses of HF were made during a hospitalization, whereas the proportion was 39% in 2017. As in-patient diagnoses decreased, out-patient diagnoses increased from 23% to 61%. Out-patients had lower mortality and hospitalization rates than in-patients throughout the study period, although the 1-year age-standardized mortality rate decreased for each of in-patients (24 to 14/100-person) and out-patients (11 to 7/100-person). 1-year and 5-year AR of death decreased by 11.1% and 17.0%, respectively, for all HF patients, while the risk of hospitalization for HF did not decrease significantly (1.13% and 0.96%, respectively). Conclusions Between 1997 and 2017, HF changed from being primarily diagnosed during hospitalization to being mostly diagnosed in the outpatient setting. Out-patients had much lower mortality rates than in-patients throughout the study period. Despite a significant decrease in mortality risk for all HF patients, neither in-patients nor out-patients experienced a reduction in the risk of a HF hospitalization.

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Section: Discussionmentioning

confidence: 96%

Importance of diagnostic setting in determining mortality in patients with new-onset heart failure: temporal trends in Denmark from 1997 to 2017

Arulmurugananthavadivel

Holt

Parveen

et al. 2021

European Heart Journal - Quality of Care and Clinical Outcomes

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“…A history of HF hospitalization is a well-recognized risk marker emphasized in clinical practice, but this could be driven by hospitalization serving as a crude surrogate for underlying patient characteristics that variably correlate with hospitalized HF populations. 4,7 These patient characteristics may explain or confound associations between HF hospitalization and mortality, and a more singular focus on objective clinical characteristics during the index patient encounter (e.g., vital signs, laboratories) could provide a more efficient and accurate means of risk assessment. Likewise, many contemporary HF clinical trials frequently include prior HF hospitalization within eligibility criteria, rather than a sole focus on enrichment criteria derived from the index presentation.…”

mentioning

confidence: 99%

Prognostic Role of Prior Heart Failure Hospitalization Among Patients Hospitalized for Worsening Chronic Heart Failure

Blumer

Mentz

Sun

et al. 2021

Circ: Heart Failure

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Background: Hospitalization for heart failure (HF) is associated with increased risk of death among patients with chronic HF. The degree to which hospitalization for HF is a distinct biologic entity with independent prognostic value versus a marker of higher risk chronic HF patients is unclear. Methods: After excluding patients with new-onset HF, the ASCEND-HF trial (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) included 4205 patients hospitalized for worsening chronic HF with reduced or preserved ejection fraction. The present analysis compared patients by presence or absence of prior HF hospitalization within 12 months and by timing of prior HF hospitalization relative to index hospitalization. Associations with 180-day all-cause mortality were assessed, including adjustment for 27 prespecified clinical factors. Results: Overall, 2241 (53.3%) patients had a HF hospitalization within the prior 12 months and 1964 (46.7%) did not. Mortality rates at 180 days were 15.5% and 11.9%, respectively. In unadjusted analyses, prior HF hospitalization was associated with increased risk of 180-day mortality (HR, 1.35 [95% CI, 1.14–1.59]; P <0.01). After adjustment, the point estimate was attenuated and the association not statistically significant (HR, 1.18 [95% CI, 0.99–1.40]; P =0.064). Similarly, after adjustment, compared with patients without prior hospitalization, prior HF hospitalization was not associated with mortality, irrespective of timing (0–4 months: HR, 1.10 [95% CI, 0.87–1.39], P =0.41; 4–8 months: HR, 0.95 [95% CI, 0.70–1.27]; P =0.72; 8–12 months: HR, 1.06 [95% CI, 0.74–1.51], P =0.77; >12 months: HR, 0.81 [95% CI, 0.63–1.06], P =0.12). Conclusions: In this cohort of patients hospitalized for worsening HF, prior HF hospitalization was not associated with 180-day mortality after comprehensively accounting for patient characteristics measured during the index patient visit. Clinical confounders measured at the point-of-care may explain previously observed associations between prior HF hospitalization and mortality, and these clinical factors may be a more direct means of predicting patient survival. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00475852.

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“…Although HFrEF trials have usually been separated into studies of either hospitalized patients or outpatients, the LIFE trial was 1 of the first multicenter HF trials that included patients in both categories (17,18). total sample size of 335 randomized subjects would provide 72% and 84% power to detect differences of 19% and 21%, respectively, for S/V compared to valsartan therapy, respectively.…”

Section: Methodsmentioning

confidence: 99%

Sacubitril/Valsartan in Advanced Heart Failure With Reduced Ejection Fraction

Mann

Greene

Givertz

et al. 2020

JACC: Heart Failure

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Outpatient versus inpatient worsening heart failure: distinguishing biology and risk from location of care

Cited by 12 publications

References 18 publications

Importance of diagnostic setting in determining mortality in patients with new-onset heart failure: temporal trends in Denmark from 1997 to 2017

Importance of diagnostic setting in determining mortality in patients with new-onset heart failure: temporal trends in Denmark from 1997 to 2017

Prognostic Role of Prior Heart Failure Hospitalization Among Patients Hospitalized for Worsening Chronic Heart Failure

Sacubitril/Valsartan in Advanced Heart Failure With Reduced Ejection Fraction

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