Author + information
- Received February 6, 2018
- Revision received March 5, 2018
- Accepted March 7, 2018
- Published online June 4, 2018.
- Stephen J. Greene, MDa,b,
- Emily C. O’Brien, PhDa,c,
- Robert J. Mentz, MDa,b,
- Nancy Luo, MDa,b,
- N. Chantelle Hardy, MPHc,
- Warren K. Laskey, MD, MPHd,
- Paul A. Heidenreich, MD, MSe,
- Chun-Lan Chang, PhDf,
- Stuart J. Turner, BPharm, MPHf,
- Clyde W. Yancy, MD, MScg,
- Adrian F. Hernandez, MD, MHSa,b,
- Lesley H. Curtis, PhDa,c,
- Pamela N. Peterson, MD, MSPHh,i,
- Gregg C. Fonarow, MDj and
- Bradley G. Hammill, DrPHa,c,∗ ()
- aDuke Clinical Research Institute, Durham, North Carolina
- bDivision of Cardiology, Duke University School of Medicine, Durham, North Carolina
- cDepartment of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- dDivision of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico
- eDepartment of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- fNovartis Pharmaceuticals Corporation, East Hanover, New Jersey
- gDivision of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- hDivision of Cardiology, Anschutz Medical Campus, University of Colorado Denver, Aurora, Colorado
- iDivision of Cardiology, Denver Health Medical Center, Denver, Colorado
- jAhmanson-UCLA Cardiomyopathy Center, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
- ↵∗Address for correspondence:
Dr. Bradley G. Hammill, Duke Clinical Research Institute, 2400 Pratt Street, Room 0311 Terrace Level, Durham, North Carolina 27705.
Background Surveys of patients with cardiovascular disease have suggested that "home-time"—being alive and out of any health care institution—is a prioritized outcome. This novel measure has not been studied among patients with heart failure (HF).
Objectives This study sought to characterize home-time following hospitalization for HF and assess its relationship with patient characteristics and traditionally reported clinical outcomes.
Methods Using GWTG-HF (Get With The Guidelines-Heart Failure) registry data, patients discharged alive from an HF hospitalization between 2011 and 2014 and ≥65 years of age were identified. Using Medicare claims, post-discharge home-time over 30-day and 1-year follow-up was calculated for each patient as the number of days alive and spent outside of a hospital, skilled nursing facility (SNF), or rehabilitation facility.
Results Among 59,736 patients, 57,992 (97.1%) and 42,153 (70.6%) had complete follow-up for home-time calculation through 30 days and 1 year, respectively. The mean home-time was 21.6 ± 11.7 days at 30 days and 243.9 ± 137.6 days at 1 year. Contributions to reduced home-time varied by follow-up period, with days spent in SNF being the largest contributor though 30 days and death being the largest contributor through 1 year. Over 1 year, 2,044 (4.8%) patients had no home-time following index hospitalization discharge, whereas 8,194 (19.4%) had 365 days of home-time. In regression models, several conditions were associated with substantially reduced home-time, including chronic obstructive pulmonary disease, renal insufficiency, and dementia. Through 1 year, home-time was highly correlated with time-to-event endpoints of death (tau = 0.72) and the composite of death or HF readmission (tau = 0.59).
Conclusions Home-time, which can be readily calculated from administrative claims data, is substantially reduced for many patients following hospitalization for HF and is highly correlated with traditional time-to-event mortality and hospitalization outcomes. Home-time represents a novel, easily measured, patient-centered endpoint that may reflect effectiveness of interventions in future HF studies.
This study was funded by Novartis Pharmaceuticals Corporation. Dr. Greene has received research support from the National Heart, Lung, and Blood Institute T32 postdoctoral training grant (T32HL069749-14), a Heart Failure Society of America/Emergency Medicine Foundation Acute Heart Failure Young Investigator Award funded by Novartis, and Novartis. Dr. O’Brien has received research support from Bristol-Myers Squibb, GlaxoSmithKline, Pfizer, Janssen Pharmaceuticals, and Novartis. Dr. Mentz has received research support and honoraria from Novartis. Dr. Chang is an employee of Novartis Pharmaceuticals Corporation; and owns stock in Novartis AG. Mr. Turner is an employee of Novartis Pharmaceuticals Corporation. Dr. Hernandez has received consulting fees from AstraZeneca, Bayer, Boston Scientific, Merck, Novartis, and Sanofi; and research support from AstraZeneca, GlaxoSmithKline, Luitpold, Merck, and Novartis. Dr. Curtis has received research support from the National Institutes of Health, Patient-Centered Outcomes Research Institute, Novartis, GlaxoSmithKline, Gilead, Boston Scientific, and St. Jude. Dr. Fonarow has received research support from the National Institutes of Health; and has served as a consultant for Amgen, Medtronic, Novartis, and St. Jude Medical. Dr. Hammill has received research support from Novartis, GlaxoSmithKline, Abbott, Boston Scientific, and St. Jude. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 6, 2018.
- Revision received March 5, 2018.
- Accepted March 7, 2018.
- 2018 American College of Cardiology Foundation
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