Abstract
Background: Surveys of patients with cardiovascular disease have suggested that “home-time”—being alive and out of any health care institution—is a prioritized outcome. This novel measure has not been studied among patients with heart failure (HF). Objectives: This study sought to characterize home-time following hospitalization for HF and assess its relationship with patient characteristics and traditionally reported clinical outcomes. Methods: Using GWTG-HF (Get With The Guidelines-Heart Failure) registry data, patients discharged alive from an HF hospitalization between 2011 and 2014 and ≥65 years of age were identified. Using Medicare claims, post-discharge home-time over 30-day and 1-year follow-up was calculated for each patient as the number of days alive and spent outside of a hospital, skilled nursing facility (SNF), or rehabilitation facility. Results: Among 59,736 patients, 57,992 (97.1%) and 42,153 (70.6%) had complete follow-up for home-time calculation through 30 days and 1 year, respectively. The mean home-time was 21.6 ± 11.7 days at 30 days and 243.9 ± 137.6 days at 1 year. Contributions to reduced home-time varied by follow-up period, with days spent in SNF being the largest contributor though 30 days and death being the largest contributor through 1 year. Over 1 year, 2,044 (4.8%) patients had no home-time following index hospitalization discharge, whereas 8,194 (19.4%) had 365 days of home-time. In regression models, several conditions were associated with substantially reduced home-time, including chronic obstructive pulmonary disease, renal insufficiency, and dementia. Through 1 year, home-time was highly correlated with time-to-event endpoints of death (tau = 0.72) and the composite of death or HF readmission (tau = 0.59). Conclusions: Home-time, which can be readily calculated from administrative claims data, is substantially reduced for many patients following hospitalization for HF and is highly correlated with traditional time-to-event mortality and hospitalization outcomes. Home-time represents a novel, easily measured, patient-centered endpoint that may reflect effectiveness of interventions in future HF studies.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2643-2652 |
| Number of pages | 10 |
| Journal | Journal of the American College of Cardiology |
| Volume | 71 |
| Issue number | 23 |
| DOIs | |
| State | Published - Jun 12 2018 |
| Externally published | Yes |
Fingerprint
Keywords
- heart failure
- hospitalization
- outcomes
- patient-centered
- post-discharge
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Home-Time After Discharge Among Patients Hospitalized With Heart Failure. / Greene, Stephen J.; O'Brien, Emily C.; Mentz, Robert J.; Luo, Nancy; Hardy, N. Chantelle; Laskey, Warren K.; Heidenreich, Paul A.; Chang, Chun Lan; Turner, Stuart J.; Yancy, Clyde W.; Hernandez, Adrian F.; Curtis, Lesley H.; Peterson, Pamela N.; Fonarow, Gregg C.; Hammill, Bradley G.
In: Journal of the American College of Cardiology, Vol. 71, No. 23, 12.06.2018, p. 2643-2652.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Home-Time After Discharge Among Patients Hospitalized With Heart Failure
AU - Greene, Stephen J.
AU - O'Brien, Emily C.
AU - Mentz, Robert J.
AU - Luo, Nancy
AU - Hardy, N. Chantelle
AU - Laskey, Warren K.
AU - Heidenreich, Paul A.
AU - Chang, Chun Lan
AU - Turner, Stuart J.
AU - Yancy, Clyde W.
AU - Hernandez, Adrian F.
AU - Curtis, Lesley H.
AU - Peterson, Pamela N.
AU - Fonarow, Gregg C.
AU - Hammill, Bradley G.
PY - 2018/6/12
Y1 - 2018/6/12
N2 - Background: Surveys of patients with cardiovascular disease have suggested that “home-time”—being alive and out of any health care institution—is a prioritized outcome. This novel measure has not been studied among patients with heart failure (HF). Objectives: This study sought to characterize home-time following hospitalization for HF and assess its relationship with patient characteristics and traditionally reported clinical outcomes. Methods: Using GWTG-HF (Get With The Guidelines-Heart Failure) registry data, patients discharged alive from an HF hospitalization between 2011 and 2014 and ≥65 years of age were identified. Using Medicare claims, post-discharge home-time over 30-day and 1-year follow-up was calculated for each patient as the number of days alive and spent outside of a hospital, skilled nursing facility (SNF), or rehabilitation facility. Results: Among 59,736 patients, 57,992 (97.1%) and 42,153 (70.6%) had complete follow-up for home-time calculation through 30 days and 1 year, respectively. The mean home-time was 21.6 ± 11.7 days at 30 days and 243.9 ± 137.6 days at 1 year. Contributions to reduced home-time varied by follow-up period, with days spent in SNF being the largest contributor though 30 days and death being the largest contributor through 1 year. Over 1 year, 2,044 (4.8%) patients had no home-time following index hospitalization discharge, whereas 8,194 (19.4%) had 365 days of home-time. In regression models, several conditions were associated with substantially reduced home-time, including chronic obstructive pulmonary disease, renal insufficiency, and dementia. Through 1 year, home-time was highly correlated with time-to-event endpoints of death (tau = 0.72) and the composite of death or HF readmission (tau = 0.59). Conclusions: Home-time, which can be readily calculated from administrative claims data, is substantially reduced for many patients following hospitalization for HF and is highly correlated with traditional time-to-event mortality and hospitalization outcomes. Home-time represents a novel, easily measured, patient-centered endpoint that may reflect effectiveness of interventions in future HF studies.
AB - Background: Surveys of patients with cardiovascular disease have suggested that “home-time”—being alive and out of any health care institution—is a prioritized outcome. This novel measure has not been studied among patients with heart failure (HF). Objectives: This study sought to characterize home-time following hospitalization for HF and assess its relationship with patient characteristics and traditionally reported clinical outcomes. Methods: Using GWTG-HF (Get With The Guidelines-Heart Failure) registry data, patients discharged alive from an HF hospitalization between 2011 and 2014 and ≥65 years of age were identified. Using Medicare claims, post-discharge home-time over 30-day and 1-year follow-up was calculated for each patient as the number of days alive and spent outside of a hospital, skilled nursing facility (SNF), or rehabilitation facility. Results: Among 59,736 patients, 57,992 (97.1%) and 42,153 (70.6%) had complete follow-up for home-time calculation through 30 days and 1 year, respectively. The mean home-time was 21.6 ± 11.7 days at 30 days and 243.9 ± 137.6 days at 1 year. Contributions to reduced home-time varied by follow-up period, with days spent in SNF being the largest contributor though 30 days and death being the largest contributor through 1 year. Over 1 year, 2,044 (4.8%) patients had no home-time following index hospitalization discharge, whereas 8,194 (19.4%) had 365 days of home-time. In regression models, several conditions were associated with substantially reduced home-time, including chronic obstructive pulmonary disease, renal insufficiency, and dementia. Through 1 year, home-time was highly correlated with time-to-event endpoints of death (tau = 0.72) and the composite of death or HF readmission (tau = 0.59). Conclusions: Home-time, which can be readily calculated from administrative claims data, is substantially reduced for many patients following hospitalization for HF and is highly correlated with traditional time-to-event mortality and hospitalization outcomes. Home-time represents a novel, easily measured, patient-centered endpoint that may reflect effectiveness of interventions in future HF studies.
KW - heart failure
KW - hospitalization
KW - outcomes
KW - patient-centered
KW - post-discharge
UR - http://www.scopus.com/inward/record.url?scp=85047513936&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85047513936&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2018.03.517
DO - 10.1016/j.jacc.2018.03.517
M3 - Article
C2 - 29880124
AN - SCOPUS:85047513936
VL - 71
SP - 2643
EP - 2652
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 23
ER -