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Hospital Admission Risk Factors for Older HF Patients

Hospital Admission Risk Factors for Older HF Patients

The number of older people with heart failure (HF) has increased considerably over the past 20 years. Currently, 80% of patients with HF are 65 or older. The costs associated with HF are more than $35 billion per year in the United States, and these costs are largely driven by hospital stays. Yet, relatively little is known about the long-term risk for hospital admission after an HF diagnosis in older people. In addition, few data are available on the role that geriatric conditions—slow gait, muscle weakness, and cognitive impairment—play in driving HF hospitalizations. Addressing Heart Failure Knowledge Gaps My colleagues and I conducted a study in which we evaluated data from a population-based sample of people aged 65 and older who were followed for up to 20 years after being diagnosed with HF. Published in the Journal of the American College of Cardiology, the study sought to identify risk factors for lifetime hospital utilization after a new HF diagnosis and to identify risk factors for hospitalization.     Three geriatric conditions—muscle weakness, slow gait, and depression—emerged as independent risk factors for hospital admission after a diagnosis of HF, even after considering other traditional cardiovascular factors. Our analysis also found that depressed ejection fraction, New York Heart Association class III or IV symptoms, diabetes, and chronic kidney disease were other independent risk factors for admission after an HF diagnosis in older patients. Implications for Future Care After HF Diagnosis The prognostic information revealed by our study may be used to help with clinical decision making and to identify potential targets for interventions after an HF diagnosis in older patients. Muscle weakness,...
Examining Trends in HF Hospitalizations

Examining Trends in HF Hospitalizations

According to recent estimates, heart failure (HF) is one of the most common reasons for hospital admission in the United States. Efforts have been made to reduce the number of hospitalizations related to HF, and several therapies have been developed over the last 20 years that have been shown to reduce disease-related hospitalizations. Furthermore, quality improvement initiatives are being developed and launched to ensure the appropriate delivery of evidence-based therapies in HF. CMS has been reporting on the quality of care and rate of HF rehospitalization for hospitals in an effort to encourage quality improvement initiatives. “While previous analyses have shown that rates of HF hospitalizations increased in the 1980s and 1990s, more recent CMS data indicate that hospitalizations with a primary diagnosis of HF in the elderly declined over the last decade,” explains Saul B. Blecker, MD, MHS. “These findings have been attributed to improvements in treatment and reductions in prevalent HF. However, most hospitalizations involving these patients are for reasons other than acute HF.” Gaining Perspective on Secondary HF Hospitalizations Quality improvement initiatives typically target only hospitalizations with a primary diagnosis of HF. As a result, these initiatives may not affect comorbid conditions that are associated with HF but are not directly caused by it. “Characterizing trends in hospitalizations with HF as a primary or secondary diagnosis can help clinicians further understand and recognize the role of cardiac disease and non-cardiac conditions,” Dr. Blecker says. “It can also help educate future initiatives to improve quality improvement initiatives.” A study by Dr. Blecker and colleagues published in the Journal of the American College of Cardiology evaluated trends in...
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