Rehospitalization for Heart Failure

Desai, Akshay S.; Stevenson, Lynne Warner

doi:10.1161/circulationaha.112.125435

Cited by 558 publications

(417 citation statements)

References 61 publications

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“…Over the past decade, HF has accounted for over 1 million hospitalizations annually 1. Readmission rates are also high, with over 50% of discharged patients readmitted within the next 6 months 2. The age‐adjusted mortality, after an admission for acute decompensated heart failure (ADHF), is ~10% at 30 days, 30% at 1 year, and as high as 50% by 5 years 1…”

Section: Introductionmentioning

confidence: 99%

Initiation, Continuation, or Withdrawal of Angiotensin‐Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction

Gilstrap

Fonarow

Desai

et al. 2017

JAHA

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122

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BackgroundGuidelines recommend continuation or initiation of guideline‐directed medical therapy, including angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers (ACEi/ARB), in hospitalized patients with heart failure with reduced ejection fraction.Methods and ResultsUsing the Get With The Guidelines‐Heart Failure Registry, we linked clinical data from 16 052 heart failure with reduced ejection fraction (ejection fraction ≤40%) patients with Medicare claims data. We divided ACEi/ARB‐eligible patients into 4 categories based on admission and discharge ACEi/ARB use: continued (reference group), started, discontinued, or not started on therapy. A multivariable Cox proportional hazard model was used to determine the association between ACEi/ARB category and outcomes. Most, 90.5%, were discharged on ACEi/ARB (59.6% continued and 30.9% newly started). Of those discharged without ACEi/ARB, 1.9% were discontinued, and 7.5% were eligible but not started. Thirty‐day mortality was 3.5% for patients continued and 4.1% for patients started on ACEi/ARB. In contrast, 30‐day mortality was 8.8% for patients discontinued (adjusted hazard ratio [HR adj] 1.92; 95% CI 1.32‐2.81; P<0.001) and 7.5% for patients not started (HR adj 1.50; 95% CI 1.12‐2.00; P=0.006). The 30‐day readmission rate was lowest among patients continued or started on therapy. One‐year mortality was 28.2% for patients continued and 29.7% for patients started on ACEi/ARB compared to 41.6% for patients discontinued (HR adj 1.35; 95% CI 1.13‐1.61; P<0.001) and 41.7% (HR adj 1.28; 95% CI 1.14‐1.43; P<0.001) for patients not started on therapy.ConclusionsCompared with continuation, withdrawal of ACEi/ARB during heart failure hospitalization is associated with higher rates of postdischarge mortality and readmission, even after adjustment for severity of illness.

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Section: Introductionmentioning

confidence: 99%

Initiation, Continuation, or Withdrawal of Angiotensin‐Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction

Gilstrap

Fonarow

Desai

et al. 2017

JAHA

Self Cite

122

View full text Add to dashboard Cite

show abstract

“…47 We found a similar readmission rate of 19.3% for NV-HAP. These rates are comparable with 30-day readmission rates for diseases that require reporting, such as congestive heart failure, 48 which may result in nonpayment or penalties as part of the U.S. Hospitals Readmission Reduction Program.…”

Section: Discussionmentioning

confidence: 70%

Understanding factors that impact on public and patient’s risk perceptions and responses toward Clostridium difficile and other health care-associated infections: A structured literature review

Burnett

Johnston

Kearney

et al. 2013

American Journal of Infection Control

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“…Racial/ethnic disparities in (re)hospitalizations among HF patients have been identified as actionable targets to reduce healthcare costs and improve patient outcomes 3, 4, 44, 45. Our study is the first prospective investigation of racial/ethnic differences in individual trajectories of hospitalization following the diagnosis of HF.…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Differences in Trajectories of Hospitalization in US Men and Women With Heart Failure

Dupre

et al. 2017

JAHA

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BackgroundPrior studies have documented racial and ethnic disparities in hospitalization among patients with heart failure (HF). However, racial/ethnic differences in trajectories of hospitalization following the diagnosis of HF have not been well characterized. This study examined racial/ethnic differences in individual‐level trajectories of hospitalization in older adults with diagnosed HF.Methods and ResultsData from a nationally representative prospective cohort of US men and women aged 45 years and older were used to examine the number of hospitalizations reported every 24 months. Participants who were non‐Hispanic white, non‐Hispanic black, and Hispanic with a reported diagnosis of HF (n=3011) were followed from 1998 to 2014. Results showed a quadratic change in the number of reported hospitalizations following HF diagnosis, with an average of 2.36 (95% confidence interval [CI], 2.19–2.53; P<0.001) hospitalizations within 24 months that decreased by 0.35 (95% CI, −0.45 to −0.25; P<0.001) every 24 months and subsequently increased by 0.03 (95% CI, 0.02–0.05; P<0.001) thereafter. In men, there were no racial/ethnic differences in hospitalizations reported at the time of diagnosis; however, Hispanic men had significant declines in hospitalizations after diagnosis (Hispanic×time=−0.52; 95% CI, −0.99 to −0.05 [P=0.031]) followed by a sizeable increase in hospitalizations at later stages of disease (Hispanic×time2=0.06; 95% CI, 0.00–0.12 [P=0.047]). In women, hospitalizations were consistently high following their diagnosis and black women had significantly more hospitalizations throughout follow‐up than white women (black=0.28; 95% CI, 0.00–0.55 [P=0.048]). Racial/ethnic disparities varied by geography and the differences remained significant after adjusting for multiple sociodemographic, psychosocial, behavioral, and physiological factors.ConclusionsThere were significant racial/ethnic differences in trajectories of hospitalization following the diagnosis of HF in US men and women. Racial/ethnic disparities varied by place of residence and the differences persisted after adjustment for multiple risk factors. The findings have important implications that may be crucial to planning the immediate and long‐term delivery of care in patients with HF to reduce potentially preventable hospitalizations.

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Rehospitalization for Heart Failure

Cited by 558 publications

References 61 publications

Initiation, Continuation, or Withdrawal of Angiotensin‐Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction

Initiation, Continuation, or Withdrawal of Angiotensin‐Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction

Understanding factors that impact on public and patient’s risk perceptions and responses toward Clostridium difficile and other health care-associated infections: A structured literature review

Racial and Ethnic Differences in Trajectories of Hospitalization in US Men and Women With Heart Failure

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