Heart failure & cardiomyopathies
Clinical and Financial Implications of Inpatient and Outpatient Management of Worsening Heart Failure
Authors' conclusion
In this nationwide analysis of older US adults, high rates of death and substantial reductions in home-time occurred following WHF regardless of inpatient or outpatient management, but were worse following HF hospitalization.
Study context
- Population
- US Medicare beneficiaries ≥65 years discharged from heart failure (HF) hospitalization (GWTG-HF registry, 2010–2018) with subsequent worsening heart failure (WHF) within 12 monthsof 181,827 eligible
- Participants
- 61,159 beneficiaries
- Exposure
- Types of first WHF event: HF hospitalization vs emergency department (ED) discharge vs observation stay vs outpatient intravenous (IV) diuretic visit
- HF hospitalizationn = 48,612
- ED visitn = 8,139
- Observation stayn = 1,767
- Outpatient IV diuretic visitn = 2,641
- Outcome
- Mortality, home-time (days alive and out of any healthcare institution) and healthcare costs
- Follow-up
- 12 months after the WHF event
Methodological detailsregistry-based, 553 US hospitals
- Registry-based
- 553 US hospitals
Main finding
As reported in the abstract
12-month mortality · 12 months
| Group | Value | Median home-time |
|---|---|---|
| HF hospitalization | cumulative IR 48.8 (95% CI 48.3–49.3) | 251 [47-351] days |
| ED visit | cumulative IR 41.2 (95% CI 40.1–42.3) | |
| Observation stay | cumulative IR 29.9 (95% CI 27.7–32.0) | 354 [206-365] days |
| Outpatient IV diuretic visit | cumulative IR 39.3 (95% CI 37.4–41.2) |
Value
HF hospitalizationcumulative IR 48.8 (95% CI 48.3–49.3)
ED visitcumulative IR 41.2 (95% CI 40.1–42.3)
Observation staycumulative IR 29.9 (95% CI 27.7–32.0)
Outpatient IV diuretic visitcumulative IR 39.3 (95% CI 37.4–41.2)
Median home-time
HF hospitalization251 [47-351] days
ED visitNot reported in the abstract
Observation stay354 [206-365] days
Outpatient IV diuretic visitNot reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | HF hospitalization | ED visit | Observation stay | Outpatient IV diuretic visit | |
|---|---|---|---|---|---|
| Median total per-patient costs of index WHF event | median US$11 335 | Not reported in the abstract | Not reported in the abstract | median US$259 | ED visit, Observation stay: not reported in the abstract |
| Median total per-patient costs over 12 months (all patients, incl. deaths) | Not reported in the abstract | Not reported in the abstract | Not reported in the abstract | median US$29 173 | HF hospitalization, ED visit, Observation stay: not reported in the abstract |
| Median total per-patient costs over 12 months (12-month survivors) | median US$30 971 | Not reported in the abstract | Not reported in the abstract | median US$29 931 | ED visit, Observation stay: not reported in the abstract |
Median total per-patient costs of index WHF event
- Highest for HF hospitalization, lowest for outpatient IV diuretic visit
Median total per-patient costs over 12 months (all patients, incl. deaths)
- Highest following outpatient IV diuretic visits
Median total per-patient costs over 12 months (12-month survivors)
- Similarly high
Original publication
Clinical and Financial Implications of Inpatient and Outpatient Management of Worsening Heart Failure. Eur J Heart Fail. Published 26 May 2025. doi:10.
Summarised from the published abstract; every number is checked against it