Abstract 342: Differences in Health Care Utilization and Outcomes Based on Timing of In-Hospital Worsening Heart Failure

Abstract

Background: Patients admitted with acute heart failure (AHF) may experience worsening symptoms requiring escalation of therapy during hospitalization. In-hospital worsening heart failure (WHF) is associated with worse in-hospital and post-discharge outcomes, but the association between timing of in-hospital WHF (i.e. early or late during hospitalization) and outcomes is unknown. Methods: Using the Acute Decompensated Heart Failure National Registry (ADHERE) and Medicare claims, we examined characteristics, outcomes, and costs of patients hospitalized for AHF. Based on previous work, in-hospital WHF was defined by use of inotropes or intravenous vasodilators, or initiation of mechanical circulatory support, hemodialysis, or ventilation. Patients with in-hospital WHF were categorized as early WHF (12-24 h after presentation) or late WHF (> 24 h after presentation). Patients were considered to have a complicated presentation if they required escalation of therapy within 12 h of presentation, or an uncomplicated hospital course if they did not require escalation of therapy during hospitalization. Results: Of 62,908 patients, 3.2% (1,990 of 62,908) had early WHF, 6.7% (4,223 of 62,908) had late WHF, 24.4% (15,361 of 62,908) had a complicated presentation, and 65.7% (41,334 of 62,908) had an uncomplicated hospital course. Patients with late WHF had the highest rate of in-hospital and post-discharge mortality, and the highest hospital costs. The complicated presentation group had lower mortality, readmissions, and Medicare payments than the early WHF group. In an adjusted analysis, late WHF was associated with higher mortality compared to early WHF, and both early and late WHF were associated with more readmissions and resultant higher costs compared to patients with an uncomplicated hospital course (Table). Conclusions: While late WHF was associated with higher mortality compared to the other groups, both early and late WHF were associated with more frequent readmissions and higher healthcare costs compared to those with an uncomplicated hospital course. Prevention of both early and late WHF may be an important focus in the care of hospitalized patients with AHF.