Analysis of Worsening Heart Failure Events in an Integrated Health Care System.

Autor:	Ambrosy AP; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA; Division of Research, Kaiser Permanente Northern California, Oakland, California, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA. Electronic address: andrew.p.ambrosy@kp.org., Parikh RV; Division of Research, Kaiser Permanente Northern California, Oakland, California, USA., Sung SH; Division of Research, Kaiser Permanente Northern California, Oakland, California, USA., Tan TC; Division of Research, Kaiser Permanente Northern California, Oakland, California, USA., Narayanan A; Department of Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA., Masson R; Department of Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA., Lam PQ; Department of Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA., Kheder K; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA., Iwahashi A; Department of Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA., Hardwick AB; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA., Fitzpatrick JK; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA., Avula HR; Department of Cardiology, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California, USA., Selby VN; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA., Ku IA; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA., Shen X; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA., Sanghera N; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA., Cristino J; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA., Go AS; Division of Research, Kaiser Permanente Northern California, Oakland, California, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA; Departments of Epidemiology, Biostatistics and Medicine, University of California-San Francisco, San Francisco, California, USA; Department of Medicine, Stanford University, Palo Alto, California, USA.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2022 Jul 12; Vol. 80 (2), pp. 111-122.
DOI:	10.1016/j.jacc.2022.04.045
Abstrakt:	Background: There is growing interest to disentangle worsening heart failure (WHF) from location of care and move away from hospitalization as a surrogate for acuity. Objectives: The purpose of this study was to describe the incidence of WHF events across the care continuum from ambulatory encounters to hospitalizations. Methods: We studied calendar year cohorts of adults with diagnosed heart failure (HF) from 2010-2019 within a large, integrated health care delivery system. Electronic health record (EHR) data were accessed for outpatient encounters, emergency department (ED) visits/observation stays, and hospitalizations. WHF was defined as ≥1 symptom, ≥2 objective findings including ≥1 sign, and ≥1 change in HF-related therapy. Symptoms and signs were ascertained using natural language processing. Results: We identified 103,138 eligible individuals with mean age 73.6 ± 13.7 years, 47.5% women, and mean left ventricular ejection fraction of 51.4% ± 13.7%. There were 1,136,750 unique encounters including 743,039 (65.4%) outpatient encounters, 224,670 (19.8%) ED visits/observation stays, and 169,041 (14.9%) hospitalizations. A total of 126,008 WHF episodes were identified, including 34,758 (27.6%) outpatient encounters, 28,301 (22.5%) ED visits/observation stays, and 62,949 (50.0%) hospitalizations. The annual incidence (events per 100 person-years) of WHF increased from 25 to 33 during the study period primarily caused by outpatient encounters (7 to 10) and ED visits/observation stays (4 to 7). The 30-day rate of hospitalizations for WHF ranged from 8.2% for outpatient encounters to 12.4% for hospitalizations. Conclusions: ED visits/observation stays and outpatient encounters account for approximately one-half of WHF events, are driving the underlying growth in HF morbidity, and portend a poor short-term prognosis. Competing Interests: Funding Support and Author Disclosures The UTILIZE-WHF study received funding from Novartis AG and the Kaiser Permanente Northern California Community Benefit Program. The funder approved the study in advance but had no formal role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Dr Ambrosy is supported by a Mentored Patient-Oriented Research Career Development Award (K23HL150159) through the National Heart, Lung, and Blood Institute; has received relevant research support through grants to his institution from Amarin Pharma, Abbott, and Novartis; and has modest reimbursement for travel from Novartis. Drs Shen, Sanghera, and Cristino are employees of Novartis AG. Dr Go has received relevant research support through grants to his institution from the National Heart, Lung, and Blood Institute; National Institute of Diabetes, Digestive and Kidney Diseases; National Institute on Aging; Amarin Pharma Inc; Novartis; Janssen Research and Development; and CSL Behring. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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