Health Care Use Before First Heart Failure Hospitalization,JACC: Heart Failure

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Health Care Use Before First Heart Failure Hospitalization
JACC: Heart Failure ( IF 10.3 ) Pub Date : 2020-11-11 , DOI: 10.1016/j.jchf.2020.07.008
Kim Anderson ₁ , Heather J Ross ₂ , Peter C Austin ₃ , Jiming Fang ₃ , Douglas S Lee ₄

Affiliation

Objectives

This study sought to describe the pattern of health care contacts in patients ultimately presenting with incident hospitalization for acute heart failure (HF) compared with chronic obstructive pulmonary disease (COPD) exacerbation or stable HF.

Background

Little is known about how effectively HF is detected before the first acute hospitalization.

Methods

We compared 79,389 patients divided into 3 matched population cohorts in Ontario, Canada (2006–2013) with incident acute HF hospitalization, incident COPD hospitalization, or stable HF. The outcome of interest was the aggregate number of health care contacts occurring in each of the thirteen 28-day periods in the year preceding the index hospitalization. Health care contacts were defined as the total number of outpatient physician visits, hospitalizations for unrelated conditions, or emergency department visits.

Results

Acutely hospitalized patients with HF had a significant increase in health care contacts as time approached the index hospitalization. Patients with acute HF had a 28% increase in health care contacts in the last time period before the index hospitalization (adjusted rate ratio [RR]: 1.28; 95% confidence interval [CI]: 1.25 to 1.31; p < 0.001) compared with matched COPD controls. Compared with stable HF, acutely hospitalized patients had a 75% increase in health care contacts during the same time period (RR: 1.75; 95% CI: 1.71 to 1.79; p < 0.001). HF patients 20 to 40 years of age had an accelerated increase in the rate of health care contacts compared with those ≥65 years of age before index HF hospitalization (RR: 1.18; 95% CI: 1.08 to 1.28; p < 0.001).

Conclusions

Patients consulted physicians multiple times before their incident acute HF hospitalization. These health care contacts could represent missed opportunities to prevent hospitalizations for HF.

中文翻译：

第一次心力衰竭住院前的医疗保健使用

目标

本研究旨在描述与慢性阻塞性肺疾病 (COPD) 恶化或稳定 HF 相比，最终因急性心力衰竭 (HF) 住院的患者的医疗保健接触模式。

背景

在第一次急性住院之前，人们对 HF 的检测效率知之甚少。

方法

我们将加拿大安大略省（2006-2013 年）分为 3 个匹配人群队列的 79,389 名患者与急性心衰住院、COPD 住院或稳定心衰进行了比较。感兴趣的结果是在指数住院前一年的 13 个 28 天期间的每一天中发生的医疗保健接触的总数。卫生保健接触者被定义为门诊医生就诊、因无关疾病住院或急诊就诊的总次数。

结果

随着时间接近指数住院，急诊 HF 住院患者的医疗保健接触者显着增加。急性心衰患者在指数住院前的最后一个时间段内的医疗保健接触增加了 28%（调整后比率 [RR]：1.28；95% 置信区间 [CI]：1.25 至 1.31；p < 0.001）匹配的 COPD 对照。与稳定的 HF 相比，急性住院患者在同一时期的医疗保健接触增加了 75%（RR：1.75；95% CI：1.71 至 1.79；p < 0.001）。与指数 HF 住院前≥65 岁的患者相比，20 至 40 岁的 HF 患者的医疗保健接触率加速增加（RR：1.18；95% CI：1.08 至 1.28；p < 0.001）。