Association of Dual Eligibility for Medicare and Medicaid With Heart Failure Quality and Outcomes Among Get With The Guidelines–Heart Failure Hospitals

2021 ◽  
Author(s):  
Ehete Bahiru ◽  
Boback Ziaeian ◽  
Corrina Moucheraud ◽  
Anubha Agarwal ◽  
Haolin Xu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Quality And Outcomes ◽  
Dual Eligibility ◽  
Get With The Guidelines

scholarly journals Regional Variations in Heart Failure Quality and Outcomes: Get With The Guidelines–Heart Failure Registry

2021 ◽  
Author(s):  
Luke C. Cunningham ◽  
Gregg C. Fonarow ◽  
Clyde W. Yancy ◽  
Shubin Sheng ◽  
Roland A. Matsouaka ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
Quality Of Care ◽  
Length Of Stay ◽  
Patient Characteristics ◽  
The United States ◽  
Short Term ◽  
Quality And Outcomes ◽  
Get With The Guidelines

Background Regional patient characteristics, care quality, and outcomes may differ based on a variety of factors among patients hospitalized for heart failure (HF). Regional disparities in outcomes of cardiovascular disease have been suggested across various regions in the United States. This study examined whether there are significant differences by region in quality of care and short‐term outcomes of hospitalized patients with HF across the United States. Methods and Results We examined regional demographics, quality measures, and short‐term outcomes across 4 US Census Bureau regions in patients hospitalized with HF and enrolled in the GWTG‐HF (Get With The Guidelines–Heart Failure) registry from 2010 to 2016. Differences in length of stay and mortality by region were examined with multivariable logistic regression. The study included 423 333 patients hospitalized for HF in 488 hospitals. Patients in the Northeast were significantly older. Completion of achievement measures, with few exceptions, were met with similar frequency across regions. Multivariable analysis demonstrated significantly lower in‐hospital mortality in the Midwest compared with the Northeast (hazard ratio, 0.64; 95% CI, 0.51–0.8; P <0.00001). The length of stay varied significantly by region with a significantly higher risk‐adjusted length of stay in the Northeast compared with other regions. Conclusions Although we did not find any substantial differences by region in quality of care in patients hospitalized for HF, risk‐adjusted inpatient mortality was found to be lower in the Midwest compared with the Northeast, and may be secondary to unmeasured differences in patient characteristics, and to longer length of stay in the Northeast.

scholarly journals “Get with the Guidelines Heart Failure Risk Score” for mortality prediction in patients undergoing MitraClip

2021 ◽  
Author(s):  
Christos Iliadis ◽  
Maximilian Spieker ◽  
Refik Kavsur ◽  
Clemens Metze ◽  
Martin Hellmich ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Score ◽  
Goodness Of Fit ◽  
Left Ventricular ◽  
Risk Scores ◽  
Left Ventricular Ejection ◽  
Goodness Of Fit Test ◽  
Ventricular Ejection Fraction ◽  
Failure Risk ◽  
Get With The Guidelines

Abstract Background Reliable risk scores in patients undergoing transcatheter edge-to-edge mitral valve repair (TMVR) are lacking. Heart failure is common in these patients, and risk scores derived from heart failure populations might help stratify TMVR patients. Methods Consecutive patients from three Heart Centers undergoing TMVR were enrolled to investigate the association of the “Get with the Guidelines Heart Failure Risk Score” (comprising the variables systolic blood pressure, urea nitrogen, blood sodium, age, heart rate, race, history of chronic obstructive lung disease) with all-cause mortality. Results Among 815 patients with available data 177 patients died during a median follow-up time of 365 days. Estimated 1-year mortality by quartiles of the score (0–37; 38–42, 43–46 and more than 46 points) was 6%, 10%, 23% and 30%, respectively (p < 0.001), with good concordance between observed and predicted mortality rates (goodness of fit test p = 0.46). Every increase of one score point was associated with a 9% increase in the hazard of mortality (95% CI 1.06–1.11%, p < 0.001). The score was associated with long-term mortality independently of left ventricular ejection fraction, NYHA class and NTproBNP, and was equally predictive in primary and secondary mitral regurgitation. Conclusion The “Get with the Guidelines Heart Failure Risk Score” showed a strong association with mortality in patients undergoing TMVR with additive information beyond traditional risk factors. Given the routinely available variables included in this score, application is easy and broadly possible. Graphic abstract

scholarly journals Prognostic significance of the get with the guidelines-heart failure (GWTG-HF) risk score in patients undergoing trans-catheter tricuspid valve repair (TTVR)

2021 ◽  
Author(s):  
Refik Kavsur ◽  
Hannah Emmi Hupp-Herschel ◽  
Atsushi Sugiura ◽  
Tetsu Tanaka ◽  
Can Öztürk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Mitral Regurgitation ◽  
Risk Stratification ◽  
Tricuspid Valve ◽  
Risk Score ◽  
Left Ventricular Ejection ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Get With The Guidelines

AbstractThe Get-With-The-Guidelines-Heart-Failure (GWTG-HF) score is a risk assessment tool to predict mortality in patients with heart-failure (HF). We aimed to evaluate the GWTG-HF score for risk stratification in HF patients with tricuspid regurgitation undergoing trans-catheter tricuspid valve repair (TTVR). In total, 181 patients who underwent TTVR via edge-to-edge repair (86%) or annuloplasty (14%) were enrolled. Patients were categorized into a low- (≤ 43 points), intermediate- (44–53 points) and high-risk score groups (≥ 54 points). TTVR led to an improvement of TR (p < 0.0001) and NYHA (p < 0.0001). Kaplan–Meier analysis and log-rank test revealed that higher GWTG-HF scores were associated with reduced rates of event-free survival regarding mortality (96% vs 89% vs 73%, respectively, p = 0.001) and hospitalization for heart failure (HHF) (89% vs 86% vs 74%, respectively, p = 0.026). After adjusting for important variables like renal function, left ventricular ejection fraction and mitral regurgitation, the GWTG-HF score remained an independent predictor of the composite endpoint of HHF or mortality (hazard ratio 1.04 per 1-point increase, p = 0.029). Other remaining predictors were renal function and mitral regurgitation. The GWTG-HF score used as a risk stratification tool of mortality and HHF maintains its prognostic value in a HF population with severe TR undergoing TTVR.

scholarly journals TEMPORAL TRENDS IN EARLY FOLLOW-UP AFTER HOSPITALIZATION FOR HEART FAILURE: DATA FROM GET WITH THE GUIDELINES-HEART FAILURE

2014 ◽  
Vol 63 (12) ◽  
pp. A745
Author(s):  
Adam DeVore ◽  
Margueritte Cox ◽  
Zubin Eapen ◽  
Clyde Yancy ◽  
Deepak Bhatt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Temporal Trends ◽  
Failure Data ◽  
Get With The Guidelines

Association of consultation between generalists and cardiologists with quality and outcomes of heart failure care

2003 ◽  
Vol 145 (6) ◽  
pp. 1086-1093 ◽  
Author(s):  
Ali Ahmed ◽  
Richard M Allman ◽  
Catarina I Kiefe ◽  
Sharina D Person ◽  
Terrence M Shaneyfelt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Failure Care ◽  
Quality And Outcomes

scholarly journals Trends in Hospice Discharge and Relative Outcomes Among Medicare Patients in the Get With The Guidelines–Heart Failure Registry

2018 ◽  
Vol 3 (10) ◽  
pp. 917 ◽  
Author(s):  
Haider J. Warraich ◽  
Haolin Xu ◽  
Adam D. DeVore ◽  
Roland Matsouaka ◽  
Paul A. Heidenreich ◽  
...  
Keyword(s):  
Heart Failure ◽  
Medicare Patients ◽  
Get With The Guidelines

Abstract TP138: Chronic Kidney Disease in Heart Failure Patients is Associated with Increased Prevalence of Atrial Fibrillation or Atrial Flutter as well as CVA/TIA

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Christopher Lu ◽  
Jack Chan ◽  
Zejia Yu ◽  
Paula Anzenberg ◽  
Mikhail Torosoff
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Risk Assessment ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Atrial Flutter ◽  
Stroke Risk ◽  
Multivariate Logistic Regression Analysis ◽  
History Of ◽  
Get With The Guidelines

Background: The CHADS-VASC score does not incorporate renal dysfunction in stroke risk assessment in patients with atrial fibrillation and the prevalence of atrial fibrillation, atrial flutter, and cerebrovascular accidents (CVA) in patients with concurrent CHF and CKD is not well investigated. Objective: Evaluate the prevalence of history of stroke, atrial fibrillation, atrial flutter in patients with CHF and CKD. Methods: Data from the single institution Get With The Guidelines- Heart Failure (GWG-HF) cohort of 2938 consecutive inpatients with known GFR was utilized. CHADS-VASC score was calculated from the GWG-HF variables. Chronic kidney disease (CKD) was defined as GFR <60 ml/min. Results: An overwhelming majority (95%) of GWG-HF patients had elevated >1 CHADS-VASC score, which was also significantly more common in patients with CKD (97.6% vs. 91.7% in patients without CKD, p<0.0001). Average CHADS-VASC score was also significantly increased in patients with CKD (4+/-1.3 vs. 3.3+/-1.4, p<0.0001). Furthermore, CKD was associated with increased prevalence of atrial fibrillation and/or flutter (45.6% vs. 35.3%, p<0.0001) and stroke history (17.5% vs. 12.3%, p=0.002). When stroke and TIA histories were removed from the CHADS-VASC score ("CHAD-VASC score"), the remaining variables were strongly predictive of stroke or TIA (14.2% vs. 3.8%, p<0.0001). In multivariate logistic regression analysis, both CHAD-VASC score (OR 2.6, 95%CI 1.3-5.4, p=0.009) and CKD (OR 1.5, 95%CI 1.2-1.8, p=0.001) were associated significantly increased odds of prior stroke or TIA. Conclusions: In patients admitted with heart failure, CKD is associated with increased prevalence of atrial fibrillation or atrial flutter as well as increased prevalence of CVA/TIA. Further prospective studies are warranted to examine whether CKD history should be included in stroke risk assessment in patients with atrial fibrillation or atrial flutter, in conjunction with existing risk assessment frameworks.

Abstract P83: Predictors of Length of Stay for HF Patients: Results from Get With the Guidelines

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
David J Whellan ◽  
Xin Zhao ◽  
Adrian F Hernandez ◽  
Eric D Peterson ◽  
Deepak L Bhatt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Length Of Stay ◽  
Vital Signs ◽  
P Value ◽  
Chi Square ◽  
Unit Increase ◽  
History Of ◽  
Multivariable Regression ◽  
Get With The Guidelines

Background: Heart failure (HF) admissions are frequent and result in significant expenditures. Identifying predictors of increased length of stay (LOS), particularly above the median LOS, may help providers set expectations for patients and target resources effectively. Methods: We analyzed HF admissions (n= 70,094) from January 2005 through April 2007 from 246 hospitals in the AHA's Get With The Guidelines-HF program. In a subset with BNP (n=44,535), baseline characteristics, admission vital signs and selected labs (BNP, creatinine, BUN, hemoglobin, and sodium) were included in a multivariable regression analysis to determine factors associated with LOS ≥4 days. Results: Patients were median age of 72, 45% female, 53% had ischemic etiology, and median LVEF was 35%. Median LOS was 4 days (25 th ,75 th 2,6). The most significant predictors of LOS ≥ 4 days were a higher admission BUN, higher heart rate, and lower SBP (Table 1). Age, insurance, race, creatinine, and LVEF were not. Conclusion: Upon admission for HF, certain vital signs, comorbidites, and laboratory values are associated with an increased likelihood of a LOS ≥ 4 days. These observations may be of value in the implementation of interventions aimed at reducing LOS and improving quality of care in HF. Variables Associated With Hospital LOS >/= 4 Days Variable Chi-Square OR Lower (95% CI) Upper (95% CI) P-value Admissioun BUN (/1 unit increase) 221.8 1.01 1.01 1.01 <.001 Admission SBP (/ 10-unit increase) 129.6 0.96 0.95 0.96 <.001 Heart Rate (/ 10-unit increase) 122.4 1.07 1.06 1.09 <.001 History of COPD/Asthma 45.8 1.19 1.13 1.25 <.001 Admission BNP (per 100-unit increase) 37.6 1.01 1.00 1.01 <.001 Female vs. Male 29.7 1.12 1.08 1.17 <.001 History of renal insufficiency 27.4 1.17 1.10 1.24 <.001 History of heart failure 18.0 0.89 0.85 0.94 <.001 Region: (MW vs. NE)
 (S vs NE)
 (W vs. NE) 17.3 0.71
 0.91
 0.71 0.60
 .077
 0.56 0.85
 1.08
 0.88 <.001

Abstract 16571: The Potential Impact of Expanding Cardiac Rehabilitation Coverage in Heart Failure: Insights From Get With the Guidelines Heart Failure

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jacob P Kelly ◽  
Brad G Hammill ◽  
Jacob A Doll ◽  
G. Michael Felker ◽  
Paul A Heidenreich ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Adverse Outcomes ◽  
P Value ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Cox Proportional Hazard Models ◽  
Expanded Criteria ◽  
Get With The Guidelines

Background: In February 2014, coverage for cardiac rehabilitation (CR) was expanded by Centers for Medicare & Medicaid to include patients with chronic symptomatic heart failure (HF) on optimal medical therapy with ejection fraction <35%. Thus, we sought to characterize the patient population newly eligible for CR based on the expanded criteria and their associated outcomes. Methods: We analyzed the Get With The Guidelines-HF registry linked to Medicare claims data from 2008-2012 to assess three groups of patients age 65 or older: previously eligible (due to prior MI, CABG, stable angina, heart valve surgery, or PCI in the previous 12 months), newly eligible, and ineligible for CR. Ineligible patients met neither criteria. Incidence rate was calculated with Kaplan-Meier estimates and Cox proportional hazard models were used to determine the association of events. Results: Among 51,665 HF patients discharged alive, 27.2% (n=14,053) were newly eligible and 14.5% were previously eligible for CR (n=7477). Newly eligible patients were more likely to be black, have atrial fibrillation and EF < 35%, while having fewer previous hospitalizations than patients previously eligible for CR. Newly eligible and ineligible patients had similar risk for 1-year mortality compared with those previously eligible (adjusted Hazard Ratio [HR] 0.95, 95% Confidence Interval [CI] 0.88-1.02, p-value=0.13 and [HR] 1.05, 95% [CI] 0.98-1.13, p-value=0.17, respectively). However, newly eligible and ineligible patients had lower risk for 1-year readmission compared with those previously eligible (adjusted [HR] 0.89, 95% [CI] 0.85-0.93, p-value<0.001 and [HR] 0.94, 95% [CI] 0.90- 0.98, p-value<0.001). Conclusions: The extension of coverage for cardiac rehabilitation has tripled the potentially eligible HF population. As these newly eligible patients are at high risk for adverse outcomes, cardiac rehabilitation should be considered.

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