Burden and Timing of Hospitalizations in Heart Failure: A Community Study.
To study the temporal distribution and causes of hospitalizations after heart failure (HF) diagnosis.



Hospitalizations were studied in 1972 Olmsted County, Minnesota, residents with incident HF from January 1, 2000, to December 31, 2011. All hospitalizations were examined for the 2 years following incident HF, and each was categorized as due to HF, other cardiovascular causes, or noncardiovascular causes. Negative binomial regression examined associations between time periods (0-30, 31-182, 183-365, and 366-730 days after diagnosis) and hospitalizations.



During the 2 years after diagnosis, 3495 hospitalizations were observed among 1336 of the 1972 patients with HF. The age- and sex-adjusted rates of hospitalizations were highest in the first 30 days after diagnosis (3.33 per person-year vs 1.33, 1.07, and 1.00 per person-year for 31-182 days, 183-365 days, and 366-730 days, respectively). The rates of hospitalizations were similar across sex, presentation of HF (inpatient or outpatient), and type of HF (preserved or reduced ejection fraction). Patients diagnosed as inpatients who had long hospital stays (>5 days) experienced more than a 30% increased risk of rehospitalization within 30 days of dismissal. Importantly, most hospitalizations (2222 of 3495 [63.6%]) were due to noncardiovascular causes, and a minority (440 of 3495 [12.6%]) were due to HF. The rates of noncardiovascular hospitalizations were higher than those for HF or other cardiovascular hospitalizations across all follow-up for all time periods after HF.



Patients with HF experience high rates of hospitalizations, particularly within the first 30 days, and mostly for noncardiovascular causes. To reduce hospitalizations in patients with HF, an integrated approach focusing on comorbidities is required.
Department of Health Sciences Research, Mayo Clinic, Rochester, MN. Electronic address: chamberlain.alanna@mayo.edu.
Alanna M
AM
Chamberlain
Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Shannon M
SM
Dunlay
Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
Yariv
Y
Gerber
Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Sheila M
SM
Manemann
Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Ruoxiang
R
Jiang
Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Susan A
SA
Weston
Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Véronique L
VL
Roger
D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000191:economics* / Q000331:legislation & jurisprudence; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008498:Medical Record Linkage; D008910:Minnesota / Q000453:epidemiology; D058991:Patient Protection and Affordable Care Act / Q000191:economics* / Q000592:standards; D010359:Patient Readmission / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D016012:Poisson Distribution; D016016:Proportional Hazards Models; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014481:United States