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Home-Time After Discharge Among Patients Hospitalized With Heart Failure.

Publication ,  Journal Article
Greene, SJ; O'Brien, EC; Mentz, RJ; Luo, N; Hardy, NC; Laskey, WK; Heidenreich, PA; Chang, C-L; Turner, SJ; Yancy, CW; Hernandez, AF ...
Published in: J Am Coll Cardiol
June 12, 2018

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.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

June 12, 2018

Volume

71

Issue

23

Start / End Page

2643 / 2652

Location

United States

Related Subject Headings

  • Self Care
  • Registries
  • Prospective Studies
  • Patient Discharge
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
  • Follow-Up Studies
  • Female
 

Citation

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Greene, S. J., O’Brien, E. C., Mentz, R. J., Luo, N., Hardy, N. C., Laskey, W. K., … Hammill, B. G. (2018). Home-Time After Discharge Among Patients Hospitalized With Heart Failure. J Am Coll Cardiol, 71(23), 2643–2652. https://doi.org/10.1016/j.jacc.2018.03.517
Greene, Stephen J., Emily C. O’Brien, Robert J. Mentz, Nancy Luo, N Chantelle Hardy, Warren K. Laskey, Paul A. Heidenreich, et al. “Home-Time After Discharge Among Patients Hospitalized With Heart Failure.J Am Coll Cardiol 71, no. 23 (June 12, 2018): 2643–52. https://doi.org/10.1016/j.jacc.2018.03.517.
Greene SJ, O’Brien EC, Mentz RJ, Luo N, Hardy NC, Laskey WK, et al. Home-Time After Discharge Among Patients Hospitalized With Heart Failure. J Am Coll Cardiol. 2018 Jun 12;71(23):2643–52.
Greene, Stephen J., et al. “Home-Time After Discharge Among Patients Hospitalized With Heart Failure.J Am Coll Cardiol, vol. 71, no. 23, June 2018, pp. 2643–52. Pubmed, doi:10.1016/j.jacc.2018.03.517.
Greene SJ, O’Brien EC, Mentz RJ, Luo N, Hardy NC, Laskey WK, Heidenreich PA, Chang C-L, Turner SJ, Yancy CW, Hernandez AF, Curtis LH, Peterson PN, Fonarow GC, Hammill BG. Home-Time After Discharge Among Patients Hospitalized With Heart Failure. J Am Coll Cardiol. 2018 Jun 12;71(23):2643–2652.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

June 12, 2018

Volume

71

Issue

23

Start / End Page

2643 / 2652

Location

United States

Related Subject Headings

  • Self Care
  • Registries
  • Prospective Studies
  • Patient Discharge
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
  • Follow-Up Studies
  • Female