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J Am Coll Cardiol, 2003; 42:1226-1233, doi:10.1016/S0735-1097(03)00947-1
© 2003 by the American College of Cardiology Foundation
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ARTICLE

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

Joel B. Braunstein, MD*{dagger},*, Gerard F. Anderson, PhD*{ddagger}, Gary Gerstenblith, MD{dagger}, Wendy Weller, PhD{ddagger}, Marlene Niefeld, MPP{ddagger}, Robert Herbert{ddagger} and Albert W. Wu, MD, MPH*{ddagger}

* Robert Wood Johnson Clinical Scholars Program, Baltimore, Maryland, USA
{dagger} Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
{ddagger} Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

Manuscript received December 26, 2002; revised manuscript received February 26, 2003, accepted April 3, 2003.

* Reprint requests and correspondence: Dr. Joel B. Braunstein, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Carnegie #568, Baltimore, Maryland 21287, USA.
jbraunst{at}jhmi.edu

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.

Key Words: ACSCambulatory care sensitive conditions • CCSClinical Classification System • CHFchronic heart failure • COPDchronic obstructive pulmonary disease • DMdiabetes mellitus • ICD-9International Classification of Diagnoses-9th revision




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