Noncardiac comorbidity increases preventable hospitalizations and mortality among medicare beneficiaries with chronic heart failure

Joel B. Braunstein, Gerard F Anderson, Gary Gerstenblith, Wendy Weller, Marlene Niefeld, Robert Herbert, Albert W Wu

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: We studied the impact of noncardiac comorbidity on potentially preventable hospitalizations and mortality in elderly patients with chronic heart failure (CHF). BACKGROUND: Chronic HF disproportionately affects older individuals, who typically have extensive comorbidity. However, little is known about how noncardiac comorbidity complicates care in these patients. METHODS: This was a cross-sectional study of 122,630 individuals age ≥65 years with CHF identified through a 5% random sample of all U.S. Medicare beneficiaries. We assessed the relationship of the 20 most common noncardiac comorbidities to one-year potentially preventable hospitalizations and total mortality. Preventable hospitalizations were determined by admissions for ambulatory care sensitive conditions using predefined criteria. RESULTS: Sixty-five percent of the sample had at least one hospitalization, of which 50% were potentially preventable. Exacerbations of CHF accounted for 55% of potentially preventable hospitalizations. Nearly 40% of patients with CHF had ≥5 noncardiac comorbidities, and this group accounted for 81% of the total inpatient hospital days experienced by all CHF patients. The risk of hospitalization and potentially preventable hospitalization strongly increased with the number of chronic conditions (both p <0.0001). After controlling for demographic factors and other diagnoses, comorbidities that were associated consistently with notably higher risks for CHF-preventable and all-cause preventable hospitalizations, and mortality, included chronic obstructive pulmonary disease/bronchiectasis, renal failure, diabetes, depression, and other lower respiratory diseases (all p <0.01). CONCLUSIONS: Noncardiac comorbidities are highly prevalent in older patients with CHF and strongly associate with adverse clinical outcomes. Cardiologists and other providers routinely caring for older patients with CHF may improve outcomes in this high-risk population by better recognizing non-CHF conditions, which may complicate traditional CHF management strategies.

Original languageEnglish (US)
Pages (from-to)1226-1233
Number of pages8
JournalJournal of the American College of Cardiology
Volume42
Issue number7
DOIs
StatePublished - Oct 1 2003

Fingerprint

Medicare
Comorbidity
Hospitalization
Heart Failure
Mortality
Bronchiectasis
Ambulatory Care
Chronic Obstructive Pulmonary Disease
Renal Insufficiency
Inpatients
Patient Care
Cross-Sectional Studies
Demography
Depression

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Noncardiac comorbidity increases preventable hospitalizations and mortality among medicare beneficiaries with chronic heart failure. / Braunstein, Joel B.; Anderson, Gerard F; Gerstenblith, Gary; Weller, Wendy; Niefeld, Marlene; Herbert, Robert; Wu, Albert W.

In: Journal of the American College of Cardiology, Vol. 42, No. 7, 01.10.2003, p. 1226-1233.

Research output: Contribution to journalArticle

@article{20b2658669d94d72a19ef5e45cc21b08,
title = "Noncardiac comorbidity increases preventable hospitalizations and mortality among medicare beneficiaries with chronic heart failure",
abstract = "OBJECTIVES: We studied the impact of noncardiac comorbidity on potentially preventable hospitalizations and mortality in elderly patients with chronic heart failure (CHF). BACKGROUND: Chronic HF disproportionately affects older individuals, who typically have extensive comorbidity. However, little is known about how noncardiac comorbidity complicates care in these patients. METHODS: This was a cross-sectional study of 122,630 individuals age ≥65 years with CHF identified through a 5{\%} random sample of all U.S. Medicare beneficiaries. We assessed the relationship of the 20 most common noncardiac comorbidities to one-year potentially preventable hospitalizations and total mortality. Preventable hospitalizations were determined by admissions for ambulatory care sensitive conditions using predefined criteria. RESULTS: Sixty-five percent of the sample had at least one hospitalization, of which 50{\%} were potentially preventable. Exacerbations of CHF accounted for 55{\%} of potentially preventable hospitalizations. Nearly 40{\%} of patients with CHF had ≥5 noncardiac comorbidities, and this group accounted for 81{\%} of the total inpatient hospital days experienced by all CHF patients. The risk of hospitalization and potentially preventable hospitalization strongly increased with the number of chronic conditions (both p <0.0001). After controlling for demographic factors and other diagnoses, comorbidities that were associated consistently with notably higher risks for CHF-preventable and all-cause preventable hospitalizations, and mortality, included chronic obstructive pulmonary disease/bronchiectasis, renal failure, diabetes, depression, and other lower respiratory diseases (all p <0.01). CONCLUSIONS: Noncardiac comorbidities are highly prevalent in older patients with CHF and strongly associate with adverse clinical outcomes. Cardiologists and other providers routinely caring for older patients with CHF may improve outcomes in this high-risk population by better recognizing non-CHF conditions, which may complicate traditional CHF management strategies.",
author = "Braunstein, {Joel B.} and Anderson, {Gerard F} and Gary Gerstenblith and Wendy Weller and Marlene Niefeld and Robert Herbert and Wu, {Albert W}",
year = "2003",
month = "10",
day = "1",
doi = "10.1016/S0735-1097(03)00947-1",
language = "English (US)",
volume = "42",
pages = "1226--1233",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "7",

}

TY - JOUR

T1 - Noncardiac comorbidity increases preventable hospitalizations and mortality among medicare beneficiaries with chronic heart failure

AU - Braunstein, Joel B.

AU - Anderson, Gerard F

AU - Gerstenblith, Gary

AU - Weller, Wendy

AU - Niefeld, Marlene

AU - Herbert, Robert

AU - Wu, Albert W

PY - 2003/10/1

Y1 - 2003/10/1

N2 - OBJECTIVES: We studied the impact of noncardiac comorbidity on potentially preventable hospitalizations and mortality in elderly patients with chronic heart failure (CHF). BACKGROUND: Chronic HF disproportionately affects older individuals, who typically have extensive comorbidity. However, little is known about how noncardiac comorbidity complicates care in these patients. METHODS: This was a cross-sectional study of 122,630 individuals age ≥65 years with CHF identified through a 5% random sample of all U.S. Medicare beneficiaries. We assessed the relationship of the 20 most common noncardiac comorbidities to one-year potentially preventable hospitalizations and total mortality. Preventable hospitalizations were determined by admissions for ambulatory care sensitive conditions using predefined criteria. RESULTS: Sixty-five percent of the sample had at least one hospitalization, of which 50% were potentially preventable. Exacerbations of CHF accounted for 55% of potentially preventable hospitalizations. Nearly 40% of patients with CHF had ≥5 noncardiac comorbidities, and this group accounted for 81% of the total inpatient hospital days experienced by all CHF patients. The risk of hospitalization and potentially preventable hospitalization strongly increased with the number of chronic conditions (both p <0.0001). After controlling for demographic factors and other diagnoses, comorbidities that were associated consistently with notably higher risks for CHF-preventable and all-cause preventable hospitalizations, and mortality, included chronic obstructive pulmonary disease/bronchiectasis, renal failure, diabetes, depression, and other lower respiratory diseases (all p <0.01). CONCLUSIONS: Noncardiac comorbidities are highly prevalent in older patients with CHF and strongly associate with adverse clinical outcomes. Cardiologists and other providers routinely caring for older patients with CHF may improve outcomes in this high-risk population by better recognizing non-CHF conditions, which may complicate traditional CHF management strategies.

AB - OBJECTIVES: We studied the impact of noncardiac comorbidity on potentially preventable hospitalizations and mortality in elderly patients with chronic heart failure (CHF). BACKGROUND: Chronic HF disproportionately affects older individuals, who typically have extensive comorbidity. However, little is known about how noncardiac comorbidity complicates care in these patients. METHODS: This was a cross-sectional study of 122,630 individuals age ≥65 years with CHF identified through a 5% random sample of all U.S. Medicare beneficiaries. We assessed the relationship of the 20 most common noncardiac comorbidities to one-year potentially preventable hospitalizations and total mortality. Preventable hospitalizations were determined by admissions for ambulatory care sensitive conditions using predefined criteria. RESULTS: Sixty-five percent of the sample had at least one hospitalization, of which 50% were potentially preventable. Exacerbations of CHF accounted for 55% of potentially preventable hospitalizations. Nearly 40% of patients with CHF had ≥5 noncardiac comorbidities, and this group accounted for 81% of the total inpatient hospital days experienced by all CHF patients. The risk of hospitalization and potentially preventable hospitalization strongly increased with the number of chronic conditions (both p <0.0001). After controlling for demographic factors and other diagnoses, comorbidities that were associated consistently with notably higher risks for CHF-preventable and all-cause preventable hospitalizations, and mortality, included chronic obstructive pulmonary disease/bronchiectasis, renal failure, diabetes, depression, and other lower respiratory diseases (all p <0.01). CONCLUSIONS: Noncardiac comorbidities are highly prevalent in older patients with CHF and strongly associate with adverse clinical outcomes. Cardiologists and other providers routinely caring for older patients with CHF may improve outcomes in this high-risk population by better recognizing non-CHF conditions, which may complicate traditional CHF management strategies.

UR - http://www.scopus.com/inward/record.url?scp=0141615813&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0141615813&partnerID=8YFLogxK

U2 - 10.1016/S0735-1097(03)00947-1

DO - 10.1016/S0735-1097(03)00947-1

M3 - Article

VL - 42

SP - 1226

EP - 1233

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 7

ER -