ARTICLE
Noncardiac comorbidity increases preventable hospitalizations and mortality among medicare beneficiaries with chronic heart failure
Joel B. Braunstein, MD* ,*,
Gerard F. Anderson, PhD* ,
Gary Gerstenblith, MD,
Wendy Weller, PhD,
Marlene Niefeld, MPP,
Robert Herbert and
Albert W. Wu, MD, MPH*
* Robert Wood Johnson Clinical Scholars Program, Baltimore, Maryland, USA
Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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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8(suppl_1):
i5 - i10.
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|
|
|
|
|
|
|
N. M. Hawkins, Z. Huang, K. S. Pieper, S. D. Solomon, L. Kober, E. J. Velazquez, K. Swedberg, M. A. Pfeffer, J. J.V. McMurray, A. P. Maggioni, et al.
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11(3):
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[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. M. Hawkins, M. C. Petrie, P. S. Jhund, G. W. Chalmers, F. G. Dunn, and J. J.V. McMurray
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11(2):
130 - 139.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A. Marrie, R. Horwitz, G. Cutter, T. Tyry, D. Campagnolo, and T. Vollmer
Comorbidity delays diagnosis and increases disability at diagnosis in MS
Neurology,
January 13, 2009;
72(2):
117 - 124.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. M. Saunders
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West J Nurs Res,
December 1, 2008;
30(8):
943 - 959.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. Stork, H. W. Hense, C. Zentgraf, I. Uebelacker, R. Jahns, G. Ertl, and C. E. Angermann
Pharmacotherapy according to treatment guidelines is associated with lower mortality in a community-based sample of patients with chronic heart failure A prospective cohort study
Eur J Heart Fail,
December 1, 2008;
10(12):
1236 - 1245.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C Tribouilloy, D Rusinaru, H Mahjoub, J-M Tartiere, L Kesri-Tartiere, S Godard, and M Peltier
Prognostic impact of diabetes mellitus in patients with heart failure and preserved ejection fraction: a prospective five-year study
Heart,
November 1, 2008;
94(11):
1450 - 1455.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Fang, G. A. Mensah, J. B. Croft, and N. L. Keenan
Heart Failure-Related Hospitalization in the U.S., 1979 to 2004
J. Am. Coll. Cardiol.,
August 5, 2008;
52(6):
428 - 434.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Butler and A. Kalogeropoulos
Worsening Heart Failure Hospitalization Epidemic: We Do Not Know How to Prevent and We Do Not Know How to Treat!
J. Am. Coll. Cardiol.,
August 5, 2008;
52(6):
435 - 437.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. M. Henkel, M. M. Redfield, S. A. Weston, Y. Gerber, and V. L. Roger
Death in Heart Failure: A Community Perspective
Circ Heart Fail,
July 1, 2008;
1(2):
91 - 97.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. M. Fabbri, F. Luppi, B. Beghe, and K. F. Rabe
Complex chronic comorbidities of COPD
Eur. Respir. J.,
January 1, 2008;
31(1):
204 - 212.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. H. Lichtman, J. A. Spertus, K. J. Reid, M. J. Radford, J. S. Rumsfeld, N. B. Allen, F. A. Masoudi, W. S. Weintraub, and H. M. Krumholz
Acute Noncardiac Conditions and In-Hospital Mortality in Patients With Acute Myocardial Infarction
Circulation,
October 23, 2007;
116(17):
1925 - 1930.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. S. Lee, J. V. Tu, P. C. Austin, P. Dorian, R. Yee, A. Chong, D. A. Alter, and A. Laupacis
Effect of Cardiac and Noncardiac Conditions on Survival After Defibrillator Implantation
J. Am. Coll. Cardiol.,
June 26, 2007;
49(25):
2408 - 2415.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Komajda, O. Hanon, M. Hochadel, F. Follath, K. Swedberg, A. Gitt, and J. G.F. Cleland
Management of octogenarians hospitalized for heart failure in Euro Heart Failure Survey I
Eur. Heart J.,
June 1, 2007;
28(11):
1310 - 1318.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. C Lang and D. M Mancini
Non-cardiac comorbidities in chronic heart failure
Heart,
June 1, 2007;
93(6):
665 - 671.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Lainscak, J. G.F. Cleland, M. J. Lenzen, F. Follath, M. Komajda, and K. Swedberg
International variations in the treatment and co-morbidity of left ventricular systolic dysfunction: Data from the EuroHeart Failure Survey
Eur J Heart Fail,
March 1, 2007;
9(3):
292 - 299.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Rozenman, R. S. Schwartz, H. Shah, and K. H. Parikh
Wireless Acoustic Communication With a Miniature Pressure Sensor in the Pulmonary Artery for Disease Surveillance and Therapy of Patients With Congestive Heart Failure
J. Am. Coll. Cardiol.,
February 20, 2007;
49(7):
784 - 789.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. C.T.F. Alves, J. Rays, R. M.S. Telles, R. F. Junior, M. Wajngarten, B. W. Romano, C. Watanabe, and G. F. Busatto
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February 1, 2007;
48(1):
22 - 30.
[Abstract]
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|
|
|
|
|
|
|
T. H. Le Jemtel, M. Padeletti, and S. Jelic
Diagnostic and Therapeutic Challenges in Patients With Coexistent Chronic Obstructive Pulmonary Disease and Chronic Heart Failure
J. Am. Coll. Cardiol.,
January 16, 2007;
49(2):
171 - 180.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. W. Smetana, B. E. Landon, A. B. Bindman, H. Burstin, R. B. Davis, J. Tjia, and E. C. Rich
A Comparison of Outcomes Resulting From Generalist vs Specialist Care for a Single Discrete Medical Condition: A Systematic Review and Methodologic Critique
Arch Intern Med,
January 8, 2007;
167(1):
10 - 20.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Groban and J. Butterworth
Perioperative management of chronic heart failure.
Anesth. Analg.,
September 1, 2006;
103(3):
557 - 575.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. G.F. Cleland, J.-C. Daubert, E. Erdmann, N. Freemantle, D. Gras, L. Kappenberger, L. Tavazzi, and on behalf of The CARE-HF Study Investigators
Longer-term effects of cardiac resynchronization therapy on mortality in heart failure [the CArdiac REsynchronization-Heart Failure (CARE-HF) trial extension phase]
Eur. Heart J.,
August 2, 2006;
27(16):
1928 - 1932.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Freemantle, P. Tharmanathan, M.J. Calvert, W.T. Abraham, J. Ghosh, and J.G.F. Cleland
Cardiac resynchronisation for patients with heart failure due to left ventricular systolic dysfunction -- a systematic review and meta-analysis
Eur J Heart Fail,
June 1, 2006;
8(4):
433 - 440.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. G.F. Cleland, H. Loh, J. Windram, K. Goode, and A. L. Clark
Threats, opportunities, and statins in the modern management of heart failure
Eur. Heart J.,
March 2, 2006;
27(6):
641 - 643.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Kosiborod, J. P. Curtis, Y. Wang, G. L. Smith, F. A. Masoudi, J. M. Foody, E. P. Havranek, and H. M. Krumholz
Anemia and Outcomes in Patients With Heart Failure: A Study From the National Heart Care Project
Arch Intern Med,
October 24, 2005;
165(19):
2237 - 2244.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Verdiani, C. Nozzoli, F. Bacci, A. Cecchin, M. S. Rutili, S. Paladini, and I. Olivotto
Pre-discharge B-type natriuretic peptide predicts early recurrence of decompensated heart failure in patients admitted to a general medical unit
Eur J Heart Fail,
June 1, 2005;
7(4):
566 - 571.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. G.F. Cleland, A. A. Louis, A. S. Rigby, U. Janssens, A. H.M.M. Balk, and TEN-HMS Investigators
Noninvasive Home Telemonitoring for Patients With Heart Failure at High Risk of Recurrent Admission and Death: The Trans-European Network-Home-Care Management System (TEN-HMS) study
J. Am. Coll. Cardiol.,
May 17, 2005;
45(10):
1654 - 1664.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J G F Cleland, A Torabi, and N K Khan
Epidemiology and management of heart failure and left ventricular systolic dysfunction in the aftermath of a myocardial infarction
Heart,
May 1, 2005;
91(suppl_2):
ii7 - ii13.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
U. Dahlstrom
Frequent non-cardiac comorbidities in patients with chronic heart failure
Eur J Heart Fail,
March 16, 2005;
7(3):
309 - 316.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Stromberg
The crucial role of patient education in heart failure
Eur J Heart Fail,
March 16, 2005;
7(3):
363 - 369.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.G.F. Cleland, J.C. Daubert, E. Erdmann, N. Freemantle, D. Gras, L. Kappenberger, W. Klein, L. Tavazzi, and On behalf of the CARE-HF study Steering Committee
Baseline characteristics of patients recruited into the CARE-HF study
Eur J Heart Fail,
March 2, 2005;
7(2):
205 - 214.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Zuccala, G. Onder, E. Marzetti, M. R. L. Monaco, M. Cesari, A. Cocchi, P. Carbonin, R. Bernabei, and for the GIFA Study Group
Use of angiotensin-converting enzyme inhibitors and variations in cognitive performance among patients with heart failure
Eur. Heart J.,
February 1, 2005;
26(3):
226 - 233.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. G.F. Cleland and K. Goode
Natriuretic peptides for heart failure. Fashionable? Useful? Necessary?
Eur J Heart Fail,
March 15, 2004;
6(3):
253 - 255.
[Full Text]
[PDF]
|
|
|
|
