Repeat Hospitalizations in Heart Failure Patients: Don’t Judge a Book by Its Cover By Kevin Self Reviewed by Elizabeth Klodas, MD, FACC  and   A new study suggests that, in most heart failure patients, repeat hospitalizations are unlikely to be due to exacerbations of the condition itself.

There are an estimated 5.3 million people in the U.S. living with heart failure (HF) and, as technology and treatment improves, this number will continue to rise. The trend is also true for the number of hospitalizations required to treat HF patients — as most of these individuals are readmitted to hospitals multiple times over the course of their lives. Patients with HF comprise one tenth of the Medicare population, but account for one third of all Medicare spending.  In 2008 alone, the estimated hospital costs were $34.8 billion. In the health care debate, re-hospitalization rates of patients with HF are often cited as an example of a quality gap (and poor return on investment) within the American health care system.

However, despite the ability to track the cost of caring for HF patients, little is known about why these patients are readmitted in the first place. This lack of information prompted a recent study at the Mayo Clinic in Rochester, MN, which investigated over 1000 patients and their history of hospitalizations after receiving a HF diagnosis. The results were quite surprising.

High hospital admission rates in this population were confirmed by the researchers.  The study found that 83 percent of all patients diagnosed with HF had at least one hospitalization within the next 4.7 years. More than half required three or more hospitalizations.  However, less than 17 percent of all those hospitalizations could be attributed to HF. This means that the vast majority of all HF patients were readmitted to hospitals due to conditions other than the HF itself.

This suggests that repeat hospitalizations in this group may not necessarily signal a failure in care quality, but rather highlight the complex nature of these patients, who often have multiple medical problems.  Indeed, respiratory tract infections, chronic lung disease, bone and joint problems, as well as diabetes and kidney disease were common indications for admission and readmission.

“For patients with heart failure this means we need to take a holistic approach so we can address those conditions associated with heart failure — like diabetes — as well as the heart failure itself,” says Dr. Veronique L. Roger in the Department of Health Sciences Research at the Mayo Clinic in Rochester, MN. “We need to find treatments that work for patients and will help minimize the amount of time spent in the hospital.”

Dr. Lynne Warner Stevenson at Brigham and Women’s Hospital and co-author of an accompanying editorial believes education is one of the best ways to address the holistic approach.

“Heart failure is a misleading term. Having heart failure does not mean that your heart is going to stop. It means that there are different levels of heart dysfunction and possibly other conditions that are contributing to overall health,” says Stevenson.

According to Stevenson, it is important for patients to know and ask how serious their heart dysfunction is and how that fits in with other aspects of their health.

Dr. Roger has similar advice, advising patients to ask what can be done to minimize the impact of heart failure and to optimize the chances of leading a long and healthy life - free of hospital admissions.

The survey results are published in the October 27, 2009 issue of the Journal of the American College of Cardiology.

Sources: 

Dunlay SM et al. Hospitalization After Heart Failure Diagnosis: A Community Perspective. Journal of the American College of Cardiology, 2009.

Setoguchi S and Stevenson LW. Hospitalization in Patients with Heart Failure: Who and Why. Journal of the American College of Cardiology, 2009.

Dr. Veronique L. Roger, Department of Health Sciences Research, Mayo Clinic, Rochester, MN

Dr. Lynne Warner Stevenson, Brigham and Women’s Hospital, Cardiovascular Division, Boston, MA