The health services burden of heart failure: an analysis using linked population health data-sets (BMC Health Services Research)

Background: The burden of patients with heart failure on health care systems is widely recognised,although there have been few attempts to quantify individual patterns of care and differencesin health service utilisation related to age, socio-economic factors and the presence of comorbidities.The aim of this study was to assess the typical profile, trajectory and resourceuse of a cohort of Australian patients with heart failure using linked population-based,patient-level data. Methods: Using hospital separations (Admitted Patient Data Collection) with death registrations(Registry of Births, Deaths and Marriages) for the period 2000-2007 we estimated age- andgender-specific rates of index admissions and readmissions, risk factors for hospitalreadmission, mean length of stay (LOS), median survival and bed-days occupied by patientswith heart failure in New South Wales, Australia. Results: We identified 29,161 index admissions for heart failure. Admission rates increased with age,and were higher for males than females for all age groups. Age-standardised rates decreasedover time (256.7 to 237.7/100,000 for males and 235.3 to 217.1/100,000 for females from2002-3 to 2006-7; p = 0.0073 adjusted for gender). Readmission rates (any cause) were 27%and 73% at 28-days and one year respectively; readmission rates for heart failure were 11%and 32% respectively. All cause mortality was 10% and 28% at 28 days and one year.Increasing age was associated with more heart failure readmissions, longer LOS and shortermedian survival. Increasing age, increasing Charlson comorbidity score and male genderwere risk factors for hospital readmission. Cohort members occupied 954,888 hospital beddaysduring the study period (any cause); 383,646 bed-days were attributed to heart failureadmissions. Conclusions: The rates of index admissions for heart failure decreased significantly in both males andfemales over the study period. However, the impact on acute care hospital beds wassubstantial, with heart failure patients occupying almost 200,000 bed-days per year in NSWover the five year study period. The strong age-related trends highlight the importance ofstabilising elderly patients before discharge and community-based outreach programs tobetter manage heart failure and reduce readmissions.