Long-term trends of use of health service among heart failure patients

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Title: Long-term trends of use of health service among heart failure patients
Authors: Rao, A
Kim, D
Darzi, A
Majeed, A
Aylin, P
Bottle, A
Item Type: Journal Article
Abstract: Aims: We aimed to identify subgroups in the patient population with different trajectories of long-term readmission rates. The study also aimed to assess common causes and their sequences of readmissions for each subgroup. 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, which contain information on 10.5 million patients. HF patients were followed up for 5 years. Group-based trajectory models and sequence analysis were applied. Results: The model categorised the HF population (n = 9466) into 5 subgroups: low-impact (66.9%); two intermediate ones (27.4%); chronic high-impact (2.3%) with steady high annual readmission rates; and short-term high-impact (3.4%) with rapid decline in readmission rates. The groups were defined by their trends of yearly number of readmissions. The all-cause 5-year mortality was highest in the short-term high-impact group (n = 185, 72.8%), followed by group 2 (intermediate users) (n = 744, 58.8%), low-impact (n = 4244, 56.9%), chronic high-impact (n = 88, 37.6%) and group 1 (intermediate users) (n = 401, 30.3%) (p < 0.01). Compared with low-impact users, high-impact users were associated with higher mortality, bereavement episodes, and more out-of-hours GP visits. The chronic high-impact users had distinct sequences of causes of emergency admissions most often consisting of chest infection, ischaemic heart disease, and cardio-pulmonary signs and/or symptoms. Conclusion: Chronic high-impact users constitute a small proportion of total patients, but they have increasingly high use of healthcare services. Short-term high-impact users represent largely end of life patients. They require prompt involvement of the palliative care team to reduce unnecessary readmissions to hospital.
Issue Date: 1-Jul-2018
Date of Acceptance: 26-Apr-2018
URI: http://hdl.handle.net/10044/1/58892
DOI: https://doi.org/10.1093/ehjqcco/qcy013
ISSN: 2058-5225
Publisher: Oxford University Press
Start Page: 220
End Page: 231
Journal / Book Title: European Heart Journal - Quality of Care and Clinical Outcomes
Volume: 4
Issue: 4
Copyright Statement: © 2018 Oxford University Press. This is a pre-copy-editing, author-produced version of an article accepted for publication in European Heart Journal following peer review. The definitive publisher-authenticated version Ahsan Rao, Dani Kim, Ara Darzi, Azeem Majeed, Paul Aylin, Alex Bottle, Long-term trends of use of health service among heart failure patients, European Heart Journal - Quality of Care and Clinical Outcomes, Volume 4, Issue 3, July 2018, Pages 220–231, https://doi.org/10.1093/ehjqcco/qcy013 is available online at: https://doi.org/10.1093/ehjqcco/qcy013.
Sponsor/Funder: Imperial College Healthcare NHS Trust
National Institute for Health Research (NIHR)
Dr Foster Intelligence
Dr Foster Intelligence
National Institute of Health Research
Funder's Grant Number: RDPSC 79560
RDPSC 79560
N/A
N/A
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Readmissions
Trajectory analysis
Sequence analysis
Healthcare visits
PRACTICE RESEARCH DATALINK
LENGTH-OF-STAY
ADMINISTRATIVE DATA
HOSPITAL READMISSION
30-DAY READMISSION
CHEST-PAIN
RISK
MORTALITY
PREDICTORS
ADMISSION
Adolescent
Adult
Aged
Aged, 80 and over
Female
Follow-Up Studies
Health Services
Heart Failure
Hospitalization
Humans
Male
Middle Aged
Morbidity
Registries
Retrospective Studies
Time Factors
United Kingdom
Young Adult
Humans
Hospitalization
Registries
Morbidity
Retrospective Studies
Follow-Up Studies
Time Factors
Adolescent
Adult
Aged
Aged, 80 and over
Middle Aged
Health Services
Female
Male
Heart Failure
Young Adult
United Kingdom
Publication Status: Published
Conference Place: England
Online Publication Date: 2018-04-28
Appears in Collections:Division of Surgery
Faculty of Medicine
Epidemiology, Public Health and Primary Care



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