title: Comparison of Risk of Re-hospitalization, All-Cause Mortality, and Medical Care Resource Utilization in Patients With Heart Failure and Preserved Versus Reduced Ejection Fraction.
abstract: Because heart failure (HF) with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) are different clinical entities with differing demographic characteristics, common HF outcomes may occur at different rates. Comparative outcome studies have been equivocal, and studies comparing resource utilization are scant. We used an observational cohort design to study 6,513 patients hospitalized for HF who had an EF measured during the hospitalization and were discharged alive within 30 days. We excluded 677 patients with borderline EF values (41% to 49%) and categorized the remaining as HFrEF (EF ≤40%, n = 2,205) and HFpEF (EF >50%, n = 3,631). Patients were followed for up to 1 year for all-cause re-hospitalization and mortality and annualized medical resource utilization. Patients with HFrEF and HFpEF experienced similar adjusted incidence rates of re-hospitalization, but those with HFrEF had a 39% increased risk of mortality at 30 days (rate ratio 1.39, 95% confidence interval 1.10 to 1.76) and 25% greater risk at 1 year (rate ratio1.25, 95% confidence interval 1.12 to 1.41). After adjustment for covariates, patients with HFpEF incurred significantly more annualized outpatient visits (21.5 vs 20.1, p = 0.002) and emergency room visits (3.24 vs 2.94, p = 0.002) than those with HFrEF, but absolute differences were small. High inpatient and pharmacy utilization did not differ. Our study suggests that whether a patient has HFrEF or HFpEF has little bearing on risk of re-hospitalization or inpatient resource utilization in the year after an HF hospitalization. Both groups experienced high mortality, but those with HFrEF had greater risk. In conclusion, from the standpoint of resource use, HF can be considered a single entity.
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon. Electronic address: greg.nichols@kpchr.org.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Nichols
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
authors.forename: Kristi
authors.initials: K
authors.lastname: Reynolds
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Kimes
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon.
authors.forename: A Gabriela
authors.initials: AG
authors.lastname: Rosales
authors.affiliation: Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey.
authors.forename: Wing W
authors.initials: WW
authors.lastname: Chan
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016277:Ventricular Function, Left