title: Differences in health care use and outcomes by the timing of in-hospital worsening heart failure.
abstract: BACKGROUND
  Patients hospitalized with acute heart failure may experience worsening symptoms requiring escalation of therapy. In-hospital worsening heart failure is associated with worse in-hospital and postdischarge outcomes, but associations between the timing of worsening heart failure and outcomes are unknown.
  
  
  METHODS
  Using data from a large clinical registry linked to Medicare claims, we examined characteristics, outcomes, and costs of patients hospitalized for acute heart failure. We defined in-hospital worsening heart failure by the use of inotropes or intravenous vasodilators or initiation of mechanical circulatory support, hemodialysis, or ventilation. The study groups were early worsening heart failure (n = 1,990), late worsening heart failure (n = 4,223), complicated presentation (n = 15,361), and uncomplicated hospital course (n = 41,334).
  
  
  RESULTS
  Among 62,908 patients, those with late in-hospital worsening heart failure had higher in-hospital and postdischarge mortality than patients with early worsening heart failure or complicated presentation. Those with early or late worsening heart failure had more frequent all-cause and heart failure readmissions at 30 days and 1 year, with resultant higher costs, compared with patients with an uncomplicated hospital course.
  
  
  CONCLUSIONS
  Although late worsening heart failure was associated with the highest mortality, both early and late worsening heart failures were associated with more frequent readmissions and higher health care costs compared to uncomplicated hospital course. Prevention of worsening heart failure may be an important focus in the care of hospitalized patients with acute heart failure.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC. Electronic address: lauren.b.cooper@duke.edu.
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Cooper
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Hammill
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, NJ.
authors.forename: Puza P
authors.initials: PP
authors.lastname: Sharma
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Adam D
authors.initials: AD
authors.lastname: DeVore
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, CA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Pang
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006333:Heart Failure / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D020380:Needs Assessment; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data; D055502:Secondary Prevention / Q000379:methods; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents