Associations of Patient Demographic Characteristics and Regional Physician Density With Early Physician Follow-Up Among Medicare Beneficiaries Hospitalized With Heart Failure

Introduction: The association between baseline patient characteristics and the long-term utilization of transthoracic echocardiography (TTE) is unknown and may help focus value-based care initiatives. Methods: TTE reports from patients with ≥ 2 TTEs at our institution were linked to 100% Medicare Fee-for-service inpatient claims, 1/1/2000 – 12/31/2017. To avoid inclusion of individuals with short-interval follow-up, TTEs with < 1 year between studies were excluded. Validated claims algorithms were used to create 12 baseline cardiovascular comorbidities. Multivariable Poisson regression was used to estimate adjusted rates of TTE intensity according to baseline comorbidities. Results: Over a median (IQR) follow-up of 5.8 (3.1 – 9.5) years, 18,579 individuals (69.3 ± 12.8 years; 50.5% female) underwent a total of 59,759 TTEs (range 2 – 59). The median TTE intensity was 0.64 TTEs/patient/year (IQR 0.35 – 1.24; range 0.11 – 22.02). The top five contributors to TTE intensity were heart failure, chronic kidney disease, history of myocardial infarction, smoking, and hyperlipidemia ( Figure ). Female sex was associated with decreased TTE utilization (adjusted RR 0.95, 95% CI 0.94-0.96, p < 0.0001). Atrial fibrillation, hypertension, and history of ischemic stroke or transient ischemic attack were not significantly related to TTE intensity after multivariable adjustment (all p > 0.05). Conclusions: Among Medicare beneficiaries with ≥ 2 TTEs at our institution, the median TTE intensity was 0.64 TTEs/patient/year but varied widely. Heart failure, chronic kidney disease, and history of myocardial infarction were the strongest predictors of increased utilization. Female sex was associated with decreased utilization, reflecting broader disparities in utilization of cardiovascular procedures. Further research is needed to clarify reasons for this sex disparity and associations with cardiovascular outcomes.

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EARLY PHYSICIAN FOLLOW-UP AND 30-DAY READMISSION AMONG MEDICARE BENEFICIARIES HOSPITALIZED WITH HEART FAILURE: DATA FROM OPTIMIZE-HF AND GWTG-HF

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(10)61205-3 ◽

2010 ◽

Vol 55 (10) ◽

pp. A129.E1204

Author(s):

Adrian F. Hernandez ◽

Melissa A. Greiner ◽

Gregg C. Fonarow ◽

Bradley G. Hammill ◽

Paul A. Heidenreich ◽

...

Keyword(s):

Heart Failure ◽

Medicare Beneficiaries ◽

Failure Data

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Relationship Between Early Physician Follow-up and 30-Day Readmission Among Medicare Beneficiaries Hospitalized for Heart Failure

JAMA ◽

10.1001/jama.2010.533 ◽

2010 ◽

Vol 303 (17) ◽

pp. 1716 ◽

Cited By ~ 644

Author(s):

Adrian F. Hernandez

Keyword(s):

Heart Failure ◽

Medicare Beneficiaries

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Nonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries

Journal of the American Heart Association ◽

10.1161/jaha.121.021654 ◽

2021 ◽

Author(s):

Marat Fudim ◽

Lin Zhong ◽

Kershaw V. Patel ◽

Rohan Khera ◽

Manal F. Abdelmalek ◽

...

Keyword(s):

Heart Failure ◽

Liver Disease ◽

Ejection Fraction ◽

Fatty Liver Disease ◽

Preserved Ejection Fraction ◽

Medicare Beneficiaries ◽

Nonalcoholic Fatty Liver ◽

Reduced Ejection Fraction ◽

Increased Risk

Background Nonalcoholic fatty liver disease (NAFLD) and heart failure (HF) are increasing in prevalence. The independent association between NAFLD and downstream risk of HF and HF subtypes (HF with preserved ejection fraction and HF with reduced ejection fraction) is not well established. Methods and Results This was a retrospective, cohort study among Medicare beneficiaries. We selected Medicare beneficiaries without known prior diagnosis of HF. NAFLD was defined using presence of 1 inpatient or 2 outpatient claims using International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD‐9‐CM ), claims codes. Incident HF was defined using at least 1 inpatient or at least 2 outpatient HF claims during the follow‐up period (October 2015–December 2016). Among 870 535 Medicare patients, 3.2% (N=27 919) had a clinical diagnosis of NAFLD. Patients with NAFLD were more commonly women, were less commonly Black patients, and had a higher burden of comorbidities, such as diabetes, obesity, and kidney disease. Over a mean 14.3 months of follow‐up, patients with (versus without) baseline NAFLD had a significantly higher risk of new‐onset HF in unadjusted (6.4% versus 5.0%; P <0.001) and adjusted (adjusted hazard ratio [HR] [95% CI], 1.23 [1.18–1.29]) analyses. Among HF subtypes, the association of NAFLD with downstream risk of HF was stronger for HF with preserved ejection fraction (adjusted HR [95% CI], 1.24 [1.14–1.34]) compared with HF with reduced ejection fraction (adjusted HR [95% CI], 1.09 [0.98–1.2]). Conclusions Patients with NAFLD are at an increased risk of incident HF, with a higher risk of developing HF with preserved ejection fraction versus HF with reduced ejection fraction. The persistence of an increased risk after adjustment for clinical and demographic factors suggests an epidemiological link between NAFLD and HF beyond the basis of shared risk factors that requires further investigation.

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Abstract P387: Length of Stay Among Medicare Beneficiaries Hospitalized with Heart Failure

Circulation ◽

10.1161/circ.131.suppl_1.p387 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Emily B Levitan ◽

Melissa K Van Dyke ◽

Ligong Chen ◽

Meredith L Kilgore ◽

Todd M Brown ◽

...

Keyword(s):

Heart Failure ◽

Length Of Stay ◽

Systolic Dysfunction ◽

Skilled Nursing Facility ◽

The United States ◽

Demographic Characteristics ◽

Hospital Length Of Stay ◽

Medicare Beneficiaries ◽

Nursing Facility ◽

Skilled Nursing

Background: Heart failure (HF) is among the most common reasons for hospitalization in the United States. Hospital length of stay (LOS) is a driver of cost and disease burden. Objectives: To examine factors associated with LOS of HF hospitalizations. Methods: Medicare beneficiaries with fee-for-service and pharmacy coverage who had HF hospitalizations (inpatient claims with ≥1 overnight stay/2 hospital days with HF as the primary discharge diagnosis, discharged alive) between 2007 and 2011 were identified in the Medicare national 5% sample. The median and interquartile range (IQR) LOS was calculated by demographic characteristics, comorbidities, and discharge status based on Medicare claims data with the Kruskal-Wallis test to compare distributions in the overall population with HF (n = 45,584) and in the subpopulation with documented systolic dysfunction (n = 10,256). Results: The median LOS was 5 days (range 2-255, IQR 4-8 days) in the overall HF population and 5 days (range 2-204, IQR 4-8 days) in those with systolic dysfunction. Across most demographic characteristics and comorbidities, the median LOS was 5 days but was higher among nursing home residents and individuals with malnutrition in both groups and with chronic kidney disease in those with systolic dysfunction ( Figure ). All comorbidities were associated with a shift in the distribution toward longer LOS in the population with systolic dysfunction and all but coronary heart disease in the overall population (p < 0.001). HF patients discharged to a skilled nursing facility had longer LOS (median 7 days, IQR 5-10 days) versus other discharge statuses (median 5 days, IQR 3-7 days, p < 0.001) in both populations. Conclusions: In patients hospitalized for HF, the median LOS was 5 days across most comorbidities and other characteristics, but comorbidities were associated with a shift in the upper tail of the distribution toward longer LOS. Worse functional status (nursing residence or discharge to a skilled nursing facility) was associated with a higher median LOS.

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Abstract 17212: 30-day All-cause Readmission is Associated With a Significantly Higher Subsequent All-cause Mortality and Costly Readmissions Among Older Medicare Beneficiaries Hospitalized for Heart Failure

Circulation ◽

10.1161/circ.132.suppl_3.17212 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Cherinne Arundel ◽

Rahul Khosla ◽

Charles Faselis ◽

Charity J Morgan ◽

Sijian Zhang ◽

...

Keyword(s):

Heart Failure ◽

Length Of Stay ◽

Propensity Scores ◽

Matched Cohort ◽

Medicare Beneficiaries ◽

Post Discharge ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

Cumulative Length

Background: Among ambulatory patients with heart failure (HF), hospital admission is associated with higher subsequent mortality. HF is the leading cause of 30-day all-cause readmission, reduction of which is a goal of the Affordable Care Act. We examined the association of 30-day all-cause readmission with subsequent all-cause mortality in a propensity-matched cohort of hospitalized HF patients. Methods: Of the 8049 Medicare beneficiaries hospitalized for HF and discharged alive from 106 U.S. hospitals (1998-2001), 7578 were alive 30-day post-discharge, of which 1519 had 30-day all-cause readmission. Using propensity scores for 30-day all-cause readmission, we assembled a matched cohort of 1516 pairs of patients with and without 30-day all-cause readmission, balanced on 34 baseline characteristics. Results: During 2-12 months of post-discharge follow-up, all-cause mortality occurred in 41% and 27% of matched patients with and without 30-day all-cause readmission, respectively (HR, 1.68; 95% CI, 1.48-1.90; p<0.001; Figure). During a mean post-index follow up of 3 (max 9) years, patients with 30-day all-cause readmissions (vs. without) had higher total of post-index readmissions (mean, 6.9 vs 5.1; p<0.001), longer cumulative length of stay (mean, 51 vs 43 days; p<0.001), and higher charges (mean, $129,175 vs. $114,787; p=0.012) and payments (mean, $38,972 vs. $34,025; p=0.001) from those readmissions. Conclusions: Among hospitalized patients with HF 30-day all-cause readmission is associated with higher subsequent mortality, number of readmissions and costs, and longer cumulative length of stay.

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Clinico-demographic characteristics of the patients with decompensated chronic heart failure Clinico-demographic characteristics of the patients with decompensated chronic heart failure

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2011-2-75-80 ◽

2011 ◽

Vol 10 (2) ◽

pp. 75-80

Author(s):

S. N. Tereshchenko ◽

I. V. Kositsyna ◽

N. A. Dzhaiani ◽

N. A. Gnidkina ◽

A. V. Golubev

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Diuretic Therapy ◽

Therapy Resistance ◽

Demographic Characteristics ◽

Hemoglobin Level ◽

Hospital Treatment ◽

Moscow City ◽

The Mean

Aim. To study clinico-demographical characteristics of the patients with decompensated chronic heart failure (CHF). Material and methods. The analysis included the data of 112 patients hospitalised at Moscow City Clinical Hospital No. 68 due to decompensated CHF. The follow-up period lasted 30 days. Results. The mean age of the patients (33 % men, 67 % women) was 70,3±9,9 years. Older age (>70 years) was significantly more prevalent in women than in men (р=0,005). The main reason for CHF decompensation was inadequate pre-hospital therapy. The mean duration of the in-hospital treatment was 17,5±6,4 days. The level of 30-day fatality was 12,5 % (n=14). According to correlation analysis results, systolic blood pressure (SBP) level <100 mm Hg positively correlated with 30-day fatality (r=0,4; р=0,0001). Hemoglobin level <100 g/l also positively correlated with 30-day fatality (r=0,3; р=0,05). Conclusion. The prevalence of decompensated CHF is higher in women. Compared to men, women develop CHF in more advanced age. The main fatality-associated factors were low hemoglobin level, SBP <100 mm Hg, and age >70 years. The leading causes of death were pulmonary thromboembolism and diuretic therapy resistance.

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Abstract 9: Consistency of Laboratory Monitoring during Initiation of Mineralocorticoid Receptor Antagonists in Heart Failure

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.8.suppl_2.9 ◽

2015 ◽

Vol 8 (suppl_2) ◽

Author(s):

Lauren B Cooper ◽

Bradley G Hammill ◽

Eric D Peterson ◽

Bertram Pitt ◽

Matthew L Maciejewski ◽

...

Keyword(s):

Heart Failure ◽

Adverse Events ◽

Laboratory Testing ◽

Mineralocorticoid Receptor ◽

Laboratory Monitoring ◽

Medicare Beneficiaries ◽

Mineralocorticoid Receptor Antagonists ◽

Receptor Antagonists ◽

Laboratory Results

Introduction: The ACC/AHA heart failure guidelines recommend routine monitoring of serum potassium and renal function of patients treated with mineralocorticoid receptor antagonists (MRAs). However, compliance with these safety recommendations in routine clinical practice is unknown. Methods: We analyzed a cohort of Medicare beneficiaries in 10 states with prevalent heart failure as of July 1, 2011 and incident MRA use between May 1, 2011 and September 30, 2011. Medicare claims data were linked to laboratory results data from a large vendor. Outcomes included guideline recommended testing of serum creatinine and potassium prior to MRA initiation as well as follow-up testing in the early (day 1-10) and extended (day 11-90) post-initiation periods. Additional outcomes included abnormal laboratory results and adverse events proximate to MRA initiation. Results: We identified 10,443 Medicare beneficiaries with heart failure started on an MRA with 19.7% (2,056 of 10,443) initiated during a hospitalization. The table displays the frequency of laboratory testing before and after inpatient or outpatient MRA initiation. While overall 91.6% (9,564 of 10,443) of patients received appropriate pre-initiation testing, only 13.3% (1,384 of 10,443) received appropriate early post-initiation testing and 29.9% (3,122 of 10,443) received appropriate extended post-initiation testing. Among those patients initiated on an MRA during a hospitalization, 25.2% (518 of 2,056) had appropriate testing across all time periods. Chronic kidney disease was associated with increased likelihood of appropriate laboratory testing (RR 1.83, 95% CI: 1.58, 2.13), as was concomitant diuretic use (RR 1.78, 95% CI: 1.44, 2.21). In the early follow-up period, 1.8% (184 of 10,443) of overall patients started on a MRA had hyperkalemia or acute renal insufficiency requiring hospitalization or emergency department visit, and 8.7% (910 of 10,443) experienced these adverse events within the 90-day follow-up period. Conclusions: Rates of guideline recommended laboratory monitoring of creatinine and potassium after MRA initiation were low, which represents an area for quality improvement to ensure MRAs can safely and effectively be used in care of heart failure patients.

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