Heart failure & cardiomyopathiesCohort study
Clinical and Financial Implications of Inpatient and Outpatient Management of Worsening Heart Failure
- Retrospective cohort study
- registry-based
- 553 US hospitals
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
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) |
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 |
| 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 |
| 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 |
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:10.1002/ejhf.3702
Summarised from the published abstract; every number is checked against it