Outpatient and ED encounters accounted for half of worsening heart failure events, driving an increase in annual incidence from 25 to 33 per 100 person-years between 2010 and 2019.
Cohort (n=103,138)
Outpatient encounters and ED visits account for approximately half of worsening heart failure events, driving the growth in HF morbidity and indicating poor short-term prognosis.
BACKGROUND There is growing interest to disentangle worsening heart failure (WHF) from location of care and move away from hospitalization as a surrogate for acuity. OBJECTIVES The purpose of this study was to describe the incidence of WHF events across the care continuum from ambulatory encounters to hospitalizations. METHODS We studied calendar year cohorts of adults with diagnosed heart failure (HF) from 2010-2019 within a large, integrated health care delivery system. Electronic health record (EHR) data were accessed for outpatient encounters, emergency department (ED) visits/observation stays, and hospitalizations. WHF was defined as ≥1 symptom, ≥2 objective findings including ≥1 sign, and ≥1 change in HF-related therapy. Symptoms and signs were ascertained using natural language processing. RESULTS We identified 103,138 eligible individuals with mean age 73.6 ± 13.7 years, 47.5% women, and mean left ventricular ejection fraction of 51.4 ± 13.7%. There were 1,136,750 unique encounters including 743,039 (65.4%) outpatient encounters, 224,670 (19.8%) ED visits/observation stays, and 169, 041 (14.9%) hospitalizations. A total of 126,008 WHF episodes were identified, including 34,758 (27.6%) outpatient encounters, 28,301 (22.5%) ED visits/observation stays, and 62,949 (50.0%) hospitalizations. The annual incidence (events per 100 person-years) of WHF increased from 25 to 33 during the study period primarily caused by outpatient encounters (7 to 10) and ED visits/observation stays (4 to 7). The 30-day rate of hospitalizations for WHF ranged from 8.2% for outpatient encounters to 12.4% for hospitalizations. CONCLUSIONS ED visits/observation stays and outpatient encounters accounting for approximately half of WHF events, are driving the underlying growth in HF morbidity, and portend a poor short-term prognosis.
“Our research shows the true burden of worsening heart failure is greatly underestimated using traditional methods.”
Ambrosy et al. (Fri,) conducted a cohort in Heart failure (n=103,138). Worsening heart failure events across care settings was evaluated on Incidence of worsening heart failure events across the care continuum. Outpatient and ED encounters accounted for half of worsening heart failure events, driving an increase in annual incidence from 25 to 33 per 100 person-years between 2010 and 2019.