Abstract
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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2643-2652 |
| Number of pages | 10 |
| Journal | Journal of the American College of Cardiology |
| Volume | 71 |
| Issue number | 23 |
| DOIs | |
| State | Published - Jun 12 2018 |
Funding
This study was funded by Novartis Pharmaceuticals Corporation. Dr. Greene has received research support from the National Heart, Lung, and Blood Institute T32 postdoctoral training grant (T32HL069749-14), a Heart Failure Society of America/Emergency Medicine Foundation Acute Heart Failure Young Investigator Award funded by Novartis, and Novartis. Dr. O’Brien has received research support from Bristol-Myers Squibb, GlaxoSmithKline, Pfizer, Janssen Pharmaceuticals, and Novartis. Dr. Mentz has received research support and honoraria from Novartis. Dr. Chang is an employee of Novartis Pharmaceuticals Corporation; and owns stock in Novartis AG. Mr. Turner is an employee of Novartis Pharmaceuticals Corporation. Dr. Hernandez has received consulting fees from AstraZeneca, Bayer, Boston Scientific, Merck, Novartis, and Sanofi; and research support from AstraZeneca, GlaxoSmithKline, Luitpold, Merck, and Novartis. Dr. Curtis has received research support from the National Institutes of Health, Patient-Centered Outcomes Research Institute, Novartis, GlaxoSmithKline, Gilead, Boston Scientific, and St. Jude. Dr. Fonarow has received research support from the National Institutes of Health; and has served as a consultant for Amgen, Medtronic, Novartis, and St. Jude Medical. Dr. Hammill has received research support from Novartis, GlaxoSmithKline, Abbott, Boston Scientific, and St. Jude. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. In this large contemporary cohort of older patients hospitalized for HF, home-time was readily determined for >97% and >70% of patients at respective 30-day and 1-year follow-up. Substantial reductions in home-time were seen early and late after HF hospitalization, with only 56% and 19% of patients achieving 100% home-time through 30 days and 1 year post-discharge, respectively (Central Illustration). Relative contributions to reduced home-time varied by follow-up duration, with days spent in SNF being the largest contributor at 30 days and death being the largest contributor at 1 and 2 years. Similarly, relative contributions to reduced home-time at 1 year varied by baseline EF, with reduced EF patients having the largest contribution from death and preserved EF patients having the largest contribution from SNF. In regression models, several comorbidities and patient characteristics were associated with substantially reduced home-time, with the nature of many associations differing by EF. In comparisons of the home-time endpoint with traditional time-to-event post-discharge outcomes, home-time showed a high degree of correlation with time free from death and the composite of death or HF hospitalization at 1- and 2-year follow-up. Collectively, these findings support consideration of home-time as a continuous patient-centered outcome that can be effectively derived from administrative claims data for patients hospitalized with HF.
Keywords
- heart failure
- hospitalization
- outcomes
- patient-centered
- post-discharge
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
