Differences in health care use and outcomes by the timing of in-hospital worsening heart failure

Lauren B. Cooper, Bradley G. Hammill, Puza P. Sharma, Adam D. DeVore, Robert J. Mentz, Gregg C. Fonarow, Peter Pang, Lesley H. Curtis, Adrian F. Hernandez

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Patients hospitalized with acute heart failure may experience worsening symptoms requiring escalation of therapy. In-hospital worsening heart failure is associated with worse in-hospital and postdischarge outcomes, but associations between the timing of worsening heart failure and outcomes are unknown. Methods Using data from a large clinical registry linked to Medicare claims, we examined characteristics, outcomes, and costs of patients hospitalized for acute heart failure. We defined in-hospital worsening heart failure by the use of inotropes or intravenous vasodilators or initiation of mechanical circulatory support, hemodialysis, or ventilation. The study groups were early worsening heart failure (n = 1,990), late worsening heart failure (n = 4,223), complicated presentation (n = 15,361), and uncomplicated hospital course (n = 41,334). Results Among 62,908 patients, those with late in-hospital worsening heart failure had higher in-hospital and postdischarge mortality than patients with early worsening heart failure or complicated presentation. Those with early or late worsening heart failure had more frequent all-cause and heart failure readmissions at 30 days and 1 year, with resultant higher costs, compared with patients with an uncomplicated hospital course. Conclusion Although late worsening heart failure was associated with the highest mortality, both early and late worsening heart failures were associated with more frequent readmissions and higher health care costs compared to uncomplicated hospital course. Prevention of worsening heart failure may be an important focus in the care of hospitalized patients with acute heart failure.

Original languageEnglish (US)
Pages (from-to)1124-1132
Number of pages9
JournalAmerican Heart Journal
Volume170
Issue number6
DOIs
StatePublished - Dec 1 2015

Fingerprint

Heart Failure
Delivery of Health Care
Costs and Cost Analysis
Medicare
Hospital Mortality
Vasodilator Agents
Health Care Costs
Ventilation
Registries
Renal Dialysis
Patient Care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cooper, L. B., Hammill, B. G., Sharma, P. P., DeVore, A. D., Mentz, R. J., Fonarow, G. C., ... Hernandez, A. F. (2015). Differences in health care use and outcomes by the timing of in-hospital worsening heart failure. American Heart Journal, 170(6), 1124-1132. https://doi.org/10.1016/j.ahj.2015.09.001

Differences in health care use and outcomes by the timing of in-hospital worsening heart failure. / Cooper, Lauren B.; Hammill, Bradley G.; Sharma, Puza P.; DeVore, Adam D.; Mentz, Robert J.; Fonarow, Gregg C.; Pang, Peter; Curtis, Lesley H.; Hernandez, Adrian F.

In: American Heart Journal, Vol. 170, No. 6, 01.12.2015, p. 1124-1132.

Research output: Contribution to journalArticle

Cooper, LB, Hammill, BG, Sharma, PP, DeVore, AD, Mentz, RJ, Fonarow, GC, Pang, P, Curtis, LH & Hernandez, AF 2015, 'Differences in health care use and outcomes by the timing of in-hospital worsening heart failure', American Heart Journal, vol. 170, no. 6, pp. 1124-1132. https://doi.org/10.1016/j.ahj.2015.09.001
Cooper LB, Hammill BG, Sharma PP, DeVore AD, Mentz RJ, Fonarow GC et al. Differences in health care use and outcomes by the timing of in-hospital worsening heart failure. American Heart Journal. 2015 Dec 1;170(6):1124-1132. https://doi.org/10.1016/j.ahj.2015.09.001
Cooper, Lauren B. ; Hammill, Bradley G. ; Sharma, Puza P. ; DeVore, Adam D. ; Mentz, Robert J. ; Fonarow, Gregg C. ; Pang, Peter ; Curtis, Lesley H. ; Hernandez, Adrian F. / Differences in health care use and outcomes by the timing of in-hospital worsening heart failure. In: American Heart Journal. 2015 ; Vol. 170, No. 6. pp. 1124-1132.
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