Dataset Information

Regional differences in heart failure hospitalizations, mortality, and readmissions in Slovenia 2004-2012.

ABSTRACT:

Aims

Heart failure (HF) burden is displaying significant inter-regional differences within Europe and within countries. Due to limited data focusing on regional differences, our aim was to evaluate HF hospitalizations, readmissions, and mortality burden in Slovenian statistical regions.

Methods and results

The Slovenian National Hospitalization Discharge Registry was searched for HF hospitalizations in patients 20 years or over in the period 2004-12. Annual sex and age-standardized HF hospitalizations, mortality, and HF readmissions rates were calculated for Slovenia and for each Slovenian statistical region. Trends were evaluated using ANOVA. Multiple mixed effect logistic regression models, which included statistical region, admission year, sex, age, intensive care unit treatment, and co-morbidities as a fixed effect and hospital identifier as a random effect, were calculated for mortality and readmissions. Overall, 156 859 HF hospitalizations (55 522 where HF was coded as a main diagnosis and 43 606 as first HF hospitalizations) were recorded. Annual standardized rates varied considerably between statistical regions for main (220-511) and first HF hospitalization (392-721), 30 day (12.6-27.1) and 1 year mortality (66-117), and 30 day (31-80.8) and 1 year readmission (99-24) (per 100 000 patient years in 2012). Yearly decline in HF hospitalization rates was seen for national main (3.6; 0.001) and first (8.4; 0.083) HF hospitalizations, while individual regional main and first HF hospitalization trends mostly did not reach statistical significance. No relevant differences in mortality and readmission endpoints for statistical regions were seen when adjusted for patient demographics and specific co-morbidities.

Conclusions

Significant regional differences in standardized HF hospitalization, mortality, and readmissions between the regions were seen. There were no differences in mortality and readmissions between statistical regions for individual similar patients.

SUBMITTER: Omersa D

PROVIDER: S-EPMC6816070 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Regional differences in heart failure hospitalizations, mortality, and readmissions in Slovenia 2004-2012.

Omersa Daniel D Erzen Ivan I Lainscak Mitja M Farkas Jerneja J

ESC heart failure 20190702 5

<h4>Aims</h4>Heart failure (HF) burden is displaying significant inter-regional differences within Europe and within countries. Due to limited data focusing on regional differences, our aim was to evaluate HF hospitalizations, readmissions, and mortality burden in Slovenian statistical regions.<h4>Methods and results</h4>The Slovenian National Hospitalization Discharge Registry was searched for HF hospitalizations in patients 20 years or over in the period 2004-12. Annual sex and age-standardize ...[more]

PMID: 31264804

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Project description:BACKGROUND:National heart failure (HF) hospitalization rates have not been appropriately age standardized by sex or race/ethnicity. Reporting hospital utilization trends by subgroup is important for monitoring population health and developing interventions to eliminate disparities. METHODS AND RESULTS:The National Inpatient Sample (NIS) was used to estimate the crude and age-standardized rates of HF hospitalization between 2002 and 2013 by sex and race/ethnicity. Direct standardization was used to age-standardize rates to the 2000 US standard population. Relative differences between subgroups were reported. The national age-adjusted HF hospitalization rate decreased 30.8% from 526.86 to 364.66 per 100?000 between 2002 and 2013. Although hospitalizations decreased for all subgroups, the ratio of the age-standardized rate for men compared with women increased from 20% greater to 39% (P trend=0.002) between 2002 and 2013. Black men had a rate that was 229% (P trend=0.141) and black women, 240% (P trend=0.725) with reference to whites in 2013 with no significant change between 2002 and 2013. Hispanic men had a rate that was 32% greater in 2002 and the difference narrowed to 4% (P trend=0.047) greater in 2013 relative to whites. For Hispanic women, the rate was 55% greater in 2002 and narrowed to 8% greater (P trend=0.004) in 2013 relative to whites. Asian/Pacific Islander men had a 27% lower rate in 2002 that improved to 43% (P trend=0.040) lower in 2013 relative to whites. For Asian/Pacific Islander women, the hospitalization rate was 24% lower in 2002 and improved to 43% (P trend=0.021) lower in 2013 relative to whites. CONCLUSIONS:National HF hospitalization rates have decreased steadily during the recent decade. Disparities in HF burden and hospital utilization by sex and race/ethnicity persist. Significant population health interventions are needed to reduce the HF hospitalization burden among blacks. An evaluation of factors explaining the improvements in the HF hospitalization rates among Hispanics and Asian/Pacific Islanders is needed.

Project description:ImportancePublic reporting of hospitals' 30-day risk-standardized readmission rates following heart failure hospitalization and the financial penalization of hospitals with higher rates have been associated with a reduction in 30-day readmissions but have raised concerns regarding the potential for unintended consequences.ObjectiveTo examine the association of the Hospital Readmissions Reduction Program (HRRP) with readmission and mortality outcomes among patients hospitalized with heart failure within a prospective clinical registry that allows for detailed risk adjustment.Design, setting, and participantsInterrupted time-series and survival analyses of index heart failure hospitalizations were conducted from January 1, 2006, to December 31, 2014. This study included 115 245 fee-for-service Medicare beneficiaries across 416 US hospital sites participating in the American Heart Association Get With The Guidelines-Heart Failure registry. Data analysis took place from January 1, 2017, to June 8, 2017.ExposuresTime intervals related to the HRRP were before the HRRP implementation (January 1, 2006, to March 31, 2010), during the HRRP implementation (April 1, 2010, to September 30, 2012), and after the HRRP penalties went into effect (October 1, 2012, to December 31, 2014).Main outcomes and measuresRisk-adjusted 30-day and 1-year all-cause readmission and mortality rates.ResultsThe mean (SD) age of the study population (n = 115 245) was 80.5 (8.4) years, 62 927 (54.6%) were women, and 91 996 (81.3%) were white and 11 037 (9.7%) were black. The 30-day risk-adjusted readmission rate declined from 20.0% before the HRRP implementation to 18.4% in the HRRP penalties phase (hazard ratio (HR) after vs before the HRRP implementation, 0.91; 95% CI, 0.87-0.95; P < .001). In contrast, the 30-day risk-adjusted mortality rate increased from 7.2% before the HRRP implementation to 8.6% in the HRRP penalties phase (HR after vs before the HRRP implementation, 1.18; 95% CI, 1.10-1.27; P < .001). The 1-year risk-adjusted readmission and mortality rates followed a similar pattern as the 30-day outcomes. The 1-year risk-adjusted readmission rate declined from 57.2% to 56.3% (HR, 0.92; 95% CI, 0.89-0.96; P < .001), and the 1-year risk-adjusted mortality rate increased from 31.3% to 36.3% (HR, 1.10; 95% CI, 1.06-1.14; P < .001) after vs before the HRRP implementation.Conclusions and relevanceAmong fee-for-service Medicare beneficiaries discharged after heart failure hospitalizations, implementation of the HRRP was temporally associated with a reduction in 30-day and 1-year readmissions but an increase in 30-day and 1-year mortality. If confirmed, this finding may require reconsideration of the HRRP in heart failure.

Project description:AimsThe proportion of patients hospitalized for heart failure (HF) with preserved left ventricular ejection fraction (LVEF) is rising, but no approved treatment exists, in part owing to incomplete characterization of this particular HF phenotype. In order to better define the characteristics of HF phenotypes in Finland, a large cohort with 12 years' follow-up time was analysed.Methods and resultsPatients diagnosed between 2005 and 2017 at the Hospital District of Southwest Finland were stratified according to LVEF measure and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. For this retrospective registry study, previously diagnosed HF patients were defined as follows: patients with reduced ejection fraction (HFrEF; LVEF ≤ 40%; n = 4042), mid-range ejection fraction (HFmrEF; LVEF > 40-50% and NT-proBNP ≥ 125 pg/mL; n = 1468), and preserved ejection fraction (HFpEF; LVEF > 50% and NT-proBNP ≥ 125 pg/mL; n = 3122) and followed up for 15 022, 4962, and 10 097 patient-years, respectively. Cardiovascular (CV) hospitalization and mortality, influence of pre-selected covariates on hospitalization and mortality, and the proportion of HFpEF and HFmrEF patients with a drop in LVEF to HFrEF phenotype were analysed. All data were extracted from the electronic patient register. HFrEF patients were rehospitalized slightly earlier than HFpEF/HFmrEF patients, but the second, third, and fourth rehospitalization rates did not differ between the subgroups. Female gender and better kidney function were associated with reduced rehospitalizations in HFmrEF and HFrEF, with a non-significant trend in HFpEF. Each additional hospitalization was associated with a two-fold increased risk of death and 2.2- to 2.3-fold increased risk of CV death. All-cause mortality was higher in patients with HFpEF. Although CV mortality was less frequent in HFpEF patients, it was associated with increased NT-proBNP concentrations at index in all patient groups. During the 10 years following the index date, 26% of HFmrEF patients and 10% of HFpEF patients progressed to an HFrEF phenotype.ConclusionsThese findings suggest that disease progression, in terms of increased frequency of hospitalizations, and the relationship between increased number of hospitalizations and mortality are similar by LVEF phenotypes. These data highlight the importance of effective treatments that can reduce hospitalizations and suggest a role for monitoring NT-proBNP levels in the management of HFpEF patients in particular.

Dataset Information

Regional differences in heart failure hospitalizations, mortality, and readmissions in Slovenia 2004-2012.

Aims

Methods and results

Conclusions

Publications

Regional differences in heart failure hospitalizations, mortality, and readmissions in Slovenia 2004-2012.

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