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Regional variation in trajectories of long-term readmission rates among patients in England with heart failure

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Title: Regional variation in trajectories of long-term readmission rates among patients in England with heart failure
Authors: Rao, A
Dani, K
Darzi, A
Aylin, P
Majeed, A
Bottle, R
Item Type: Journal Article
Abstract: Background We aimed to compare the characteristics and types of heart failure (HF) patients termed “high-impact users”, with high long-term readmission rates, in different regions in England. This will allow clinical factors to be identified in areas with potentially poor quality of care. Methods Patients with a primary diagnosis of heart failure (HF) in the period 2008–2009 were identified using nationally representative primary care data linked to national hospital data and followed up for 5 years. Group-based trajectory models and sequence analysis were applied to their readmissions. Results In each of the 8 NHS England regions, multiple discrete groups were identified. All the regions had high-impact users. The group with an initially high readmission rate followed by a rapid decline in the rate ranged from 2.5 to 11.3% across the regions. The group with constantly high readmission rate compared with other groups ranged from 1.9 to 12.1%. Covariates that were commonly found to have an association with high-impact users among most of the regions were chronic respiratory disease, chronic renal disease, stroke, anaemia, mood disorder, and cardiac arrhythmia. Respiratory tract infection, urinary infection, cardiopulmonary signs and symptoms and exacerbation of heart failure were common causes in the sequences of readmissions among high-impact users in all regions. Conclusion There is regional variation in England in readmission and mortality rates and in the proportions of HF patients who are high-impact users.
Issue Date: 6-Apr-2019
Date of Acceptance: 20-Mar-2019
URI: http://hdl.handle.net/10044/1/69649
DOI: https://dx.doi.org/10.1186/s12872-019-1057-8
ISSN: 1471-2261
Publisher: BioMed Central
Journal / Book Title: BMC Cardiovascular Disorders
Volume: 19
Copyright Statement: © The Author(s). 2019Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Sponsor/Funder: National Institute of Health Research
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Heart failure
Regional analysis
Readmission rate
High-impact users
1102 Cardiorespiratory Medicine and Haematology
Cardiovascular System & Hematology
Publication Status: Published
Article Number: ARTN 86
Appears in Collections:Department of Surgery and Cancer
Institute of Global Health Innovation