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.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10329847 | PMC |
| http://dx.doi.org/10.1016/j.jacc.2022.04.045 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Proposal and exploration of a novel score to quantify patient-perceived burden of inflammatory bowel disease under routine care.
Intern Med J
January 2025
Crohn's Colitis Cure, Sydney, New South Wales, Australia.
Background: The burden of inflammatory bowel disease (IBD) is often reported on from a system or cost viewpoint. We created and explored a novel patient-perceived burden of disease (PPBoD) score in a large Australasian cohort.
Aim: To create and explore a novel patient-perceived burden of disease (PPBoD) score in a large Australasian cohort, and correlate PPBoD scores with demographics, disease and treatment factors.
Physician-dominated conversations: An analysis of illness understanding discussions among patients with advanced cancer.
Patient Educ Couns
January 2025
Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA. Electronic address:
Context: Effective communication between patients and oncologists is crucial, particularly around illness understanding. When this communication is asymmetric or imbalanced, it can hinder shared decision-making and lead to suboptimal clinical outcomes.
Objectives: We sought to describe physician-patient speech imbalances ("asymmetry") in illness understanding portions of discussions between oncologists and advanced cancer patients and explore potential trends related to patient characteristics.
Re-encountering the phobic cue within days after a reconsolidation intervention is crucial to observe a lasting fear reduction in spider phobia.
Mol Psychiatry
January 2025
Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
Memory reconsolidation interventions offer an exciting alternative to exposure treatment because they may target fear memories directly, thereby preventing relapse. A previous reconsolidation intervention for spider fear abruptly reduced avoidance behaviour, whereas changes in self-reported fear followed later. In this pre-registered placebo-controlled study, we first aimed to conceptually replicate these effects in spider phobia.
View Article and Find Full Text PDFLessons Learned from the Implementation of the Wake County, North Carolina EMS Medication for Opioid Use Disorder Program.
Prehosp Emerg Care
January 2025
Wake County Emergency Medical Services, 331 S. McDowell St, Raleigh, NC 27601.
Objectives: Buprenorphine has recently emerged as a prehospital treatment for opioid use disorder. Limited data exist regarding the implementation of prehospital buprenorphine programs. Our objective was to describe the development, deployment, lessons learned, and ongoing evolution of the Wake County EMS buprenorphine program using data from the first year following implementation.
View Article and Find Full Text PDFPhysician Tenure and Clinical Productivity for Internal and External Hires: A Retrospective Cohort Study.
J Gen Intern Med
January 2025
Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA.
Background: New employees generally demonstrate lower productivity than experienced colleagues in non-healthcare sectors, but there is limited evidence on how tenure affects physician productivity.
Objective: To evaluate the association between tenure and clinical productivity for attending physicians in the Veterans Health Administration (VHA) and explore whether this relationship differs by prior VHA residency or fellowship training.
Design: Retrospective cohort evaluation.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!