Home-Time, Mortality, and Readmissions among Patients Hospitalized with Heart Failure: A Baseline Prior to IMPLEMENT-HF

Amber B. Tang; Nicole Solomon; Karen Chiswell; Stephen J. Greene; Clyde W. Yancy; Mariell Jessup; Michelle Kittleson; Javed Butler; Nancy K. Sweitzer; Lee R. Goldberg; Jo Ann Lindenfeld; Eldrin F. Lewis; Pamela N. Peterson; Sara Paul; Lynn Mallas Serdynski; Christine Rutan; Michelle Congdon; Sruthi Cherkur; Gregg C. Fonarow

doi:10.1161/CIRCHEARTFAILURE.124.011795

Home-Time, Mortality, and Readmissions among Patients Hospitalized with Heart Failure: A Baseline Prior to IMPLEMENT-HF

Amber B. Tang, Nicole Solomon, Karen Chiswell, Stephen J. Greene, Clyde W. Yancy, Mariell Jessup, Michelle Kittleson, Javed Butler, Nancy K. Sweitzer, Lee R. Goldberg, Jo Ann Lindenfeld, Eldrin F. Lewis, Pamela N. Peterson, Sara Paul, Lynn Mallas Serdynski, Christine Rutan, Michelle Congdon, Sruthi Cherkur, Gregg C. Fonarow

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

BACKGROUND: Home-time is an emerging, patient-centered outcome that represents the amount of time a patient spends alive and outside of health care facility settings, comprising of hospitals, skilled nursing facilities, and acute rehabilitation centers. Studies evaluating home-time in the context of heart failure are limited, and the impact of quality improvement interventions on home-time has not been studied. METHODS: Medicare beneficiaries aged 65 years or older who were hospitalized for heart failure in the Get With the Guidelines-Heart Failure registry between 2019 and 2021 were included. Postdischarge home-time, mortality, and readmission rates at 30 days and 1 year were calculated with the goal of establishing baseline metrics before the initiation of IMPLEMENT-HF, a multicenter quality improvement program aimed at improving heart failure management. RESULTS: Overall, 66 019 patients were included across 437 sites. Median 30-day and 1-year home-time were 30 (18-30) and 333 (139-362) days, respectively. Only 22.1% of patients experienced 100% home-time in the year after discharge. Older patients spent significantly less time at home, with a median 1-year home-time of 302 (86-359) compared with 345 (211-365) days in patients over 85 and those between 65 and 74 years old, respectively (P<0.001). Black patients also experienced the least amount of home-time with only 328 (151-360) days at 1-year follow-up. Rates of heart failure readmission and all-cause mortality 1-year post-discharge were high at 29.8% and 37.0%, respectively. CONCLUSIONS: In this contemporary multicenter cohort, patients hospitalized with heart failure spent a median of 91.2% of their time in the year after discharge alive and at home, largely driven by high mortality rates. These findings serve as a preimplementation baseline for IMPLEMENT-HF, which will evaluate the impact of targeted heart failure initiatives on home-time and other clinical outcomes.

Original language	English (US)
Pages (from-to)	e011795
Journal	Circulation: Heart Failure
Volume	17
Issue number	10
DOIs	https://doi.org/10.1161/CIRCHEARTFAILURE.124.011795
State	Published - Oct 1 2024
Externally published	Yes

Keywords

heart failure
hospitals
medicare
patient discharge
registries

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1161/CIRCHEARTFAILURE.124.011795

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Tang, A. B., Solomon, N., Chiswell, K., Greene, S. J., Yancy, C. W., Jessup, M., Kittleson, M., Butler, J., Sweitzer, N. K., Goldberg, L. R., Lindenfeld, J. A., Lewis, E. F., Peterson, P. N., Paul, S., Serdynski, L. M., Rutan, C., Congdon, M., Cherkur, S., & Fonarow, G. C. (2024). Home-Time, Mortality, and Readmissions among Patients Hospitalized with Heart Failure: A Baseline Prior to IMPLEMENT-HF. Circulation: Heart Failure, 17(10), e011795. https://doi.org/10.1161/CIRCHEARTFAILURE.124.011795

Tang, AB, Solomon, N, Chiswell, K, Greene, SJ, Yancy, CW, Jessup, M, Kittleson, M, Butler, J, Sweitzer, NK, Goldberg, LR, Lindenfeld, JA, Lewis, EF, Peterson, PN, Paul, S, Serdynski, LM, Rutan, C, Congdon, M, Cherkur, S & Fonarow, GC 2024, 'Home-Time, Mortality, and Readmissions among Patients Hospitalized with Heart Failure: A Baseline Prior to IMPLEMENT-HF', Circulation: Heart Failure, vol. 17, no. 10, pp. e011795. https://doi.org/10.1161/CIRCHEARTFAILURE.124.011795

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title = "Home-Time, Mortality, and Readmissions among Patients Hospitalized with Heart Failure: A Baseline Prior to IMPLEMENT-HF",

abstract = "BACKGROUND: Home-time is an emerging, patient-centered outcome that represents the amount of time a patient spends alive and outside of health care facility settings, comprising of hospitals, skilled nursing facilities, and acute rehabilitation centers. Studies evaluating home-time in the context of heart failure are limited, and the impact of quality improvement interventions on home-time has not been studied. METHODS: Medicare beneficiaries aged 65 years or older who were hospitalized for heart failure in the Get With the Guidelines-Heart Failure registry between 2019 and 2021 were included. Postdischarge home-time, mortality, and readmission rates at 30 days and 1 year were calculated with the goal of establishing baseline metrics before the initiation of IMPLEMENT-HF, a multicenter quality improvement program aimed at improving heart failure management. RESULTS: Overall, 66 019 patients were included across 437 sites. Median 30-day and 1-year home-time were 30 (18-30) and 333 (139-362) days, respectively. Only 22.1% of patients experienced 100% home-time in the year after discharge. Older patients spent significantly less time at home, with a median 1-year home-time of 302 (86-359) compared with 345 (211-365) days in patients over 85 and those between 65 and 74 years old, respectively (P<0.001). Black patients also experienced the least amount of home-time with only 328 (151-360) days at 1-year follow-up. Rates of heart failure readmission and all-cause mortality 1-year post-discharge were high at 29.8% and 37.0%, respectively. CONCLUSIONS: In this contemporary multicenter cohort, patients hospitalized with heart failure spent a median of 91.2% of their time in the year after discharge alive and at home, largely driven by high mortality rates. These findings serve as a preimplementation baseline for IMPLEMENT-HF, which will evaluate the impact of targeted heart failure initiatives on home-time and other clinical outcomes.",

keywords = "heart failure, hospitals, medicare, patient discharge, registries",

author = "Tang, {Amber B.} and Nicole Solomon and Karen Chiswell and Greene, {Stephen J.} and Yancy, {Clyde W.} and Mariell Jessup and Michelle Kittleson and Javed Butler and Sweitzer, {Nancy K.} and Goldberg, {Lee R.} and Lindenfeld, {Jo Ann} and Lewis, {Eldrin F.} and Peterson, {Pamela N.} and Sara Paul and Serdynski, {Lynn Mallas} and Christine Rutan and Michelle Congdon and Sruthi Cherkur and Fonarow, {Gregg C.}",

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doi = "10.1161/CIRCHEARTFAILURE.124.011795",

language = "English (US)",

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TY - JOUR

T1 - Home-Time, Mortality, and Readmissions among Patients Hospitalized with Heart Failure

T2 - A Baseline Prior to IMPLEMENT-HF

AU - Tang, Amber B.

AU - Solomon, Nicole

AU - Chiswell, Karen

AU - Greene, Stephen J.

AU - Yancy, Clyde W.

AU - Jessup, Mariell

AU - Kittleson, Michelle

AU - Butler, Javed

AU - Sweitzer, Nancy K.

AU - Goldberg, Lee R.

AU - Lindenfeld, Jo Ann

AU - Lewis, Eldrin F.

AU - Peterson, Pamela N.

AU - Paul, Sara

AU - Serdynski, Lynn Mallas

AU - Rutan, Christine

AU - Congdon, Michelle

AU - Cherkur, Sruthi

AU - Fonarow, Gregg C.

PY - 2024/10/1

Y1 - 2024/10/1

N2 - BACKGROUND: Home-time is an emerging, patient-centered outcome that represents the amount of time a patient spends alive and outside of health care facility settings, comprising of hospitals, skilled nursing facilities, and acute rehabilitation centers. Studies evaluating home-time in the context of heart failure are limited, and the impact of quality improvement interventions on home-time has not been studied. METHODS: Medicare beneficiaries aged 65 years or older who were hospitalized for heart failure in the Get With the Guidelines-Heart Failure registry between 2019 and 2021 were included. Postdischarge home-time, mortality, and readmission rates at 30 days and 1 year were calculated with the goal of establishing baseline metrics before the initiation of IMPLEMENT-HF, a multicenter quality improvement program aimed at improving heart failure management. RESULTS: Overall, 66 019 patients were included across 437 sites. Median 30-day and 1-year home-time were 30 (18-30) and 333 (139-362) days, respectively. Only 22.1% of patients experienced 100% home-time in the year after discharge. Older patients spent significantly less time at home, with a median 1-year home-time of 302 (86-359) compared with 345 (211-365) days in patients over 85 and those between 65 and 74 years old, respectively (P<0.001). Black patients also experienced the least amount of home-time with only 328 (151-360) days at 1-year follow-up. Rates of heart failure readmission and all-cause mortality 1-year post-discharge were high at 29.8% and 37.0%, respectively. CONCLUSIONS: In this contemporary multicenter cohort, patients hospitalized with heart failure spent a median of 91.2% of their time in the year after discharge alive and at home, largely driven by high mortality rates. These findings serve as a preimplementation baseline for IMPLEMENT-HF, which will evaluate the impact of targeted heart failure initiatives on home-time and other clinical outcomes.

AB - BACKGROUND: Home-time is an emerging, patient-centered outcome that represents the amount of time a patient spends alive and outside of health care facility settings, comprising of hospitals, skilled nursing facilities, and acute rehabilitation centers. Studies evaluating home-time in the context of heart failure are limited, and the impact of quality improvement interventions on home-time has not been studied. METHODS: Medicare beneficiaries aged 65 years or older who were hospitalized for heart failure in the Get With the Guidelines-Heart Failure registry between 2019 and 2021 were included. Postdischarge home-time, mortality, and readmission rates at 30 days and 1 year were calculated with the goal of establishing baseline metrics before the initiation of IMPLEMENT-HF, a multicenter quality improvement program aimed at improving heart failure management. RESULTS: Overall, 66 019 patients were included across 437 sites. Median 30-day and 1-year home-time were 30 (18-30) and 333 (139-362) days, respectively. Only 22.1% of patients experienced 100% home-time in the year after discharge. Older patients spent significantly less time at home, with a median 1-year home-time of 302 (86-359) compared with 345 (211-365) days in patients over 85 and those between 65 and 74 years old, respectively (P<0.001). Black patients also experienced the least amount of home-time with only 328 (151-360) days at 1-year follow-up. Rates of heart failure readmission and all-cause mortality 1-year post-discharge were high at 29.8% and 37.0%, respectively. CONCLUSIONS: In this contemporary multicenter cohort, patients hospitalized with heart failure spent a median of 91.2% of their time in the year after discharge alive and at home, largely driven by high mortality rates. These findings serve as a preimplementation baseline for IMPLEMENT-HF, which will evaluate the impact of targeted heart failure initiatives on home-time and other clinical outcomes.

KW - heart failure

KW - hospitals

KW - medicare

KW - patient discharge

KW - registries

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Home-Time, Mortality, and Readmissions among Patients Hospitalized with Heart Failure: A Baseline Prior to IMPLEMENT-HF

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