Descriptive Characteristics of Patients Hospitalized with Congestive Heart Failure: A Brief Summary

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Descriptive Characteristics of Patients Hospitalized with Congestive Heart Failure: A Brief Summary

Abstract

Background: There are approximately 5.1 million patients with chronic, or congestive, heart failure (CHF) in the United States, accounting for one million hospital admissions, 6.5 million hospital days, and $37.2 billion in healthcare expenditure. The cost derives mainly from inpatient services including length of stay. The impetus has been to decrease LOS while improving patient outcomes. HF is associated with higher prevalence of C-Diff among hospitalized patients with common bacterial infections, even while adjusting for other C-Diff risk factors. Additionally, patients with HF and C-Diff had a significantly higher in-hospital mortality. There is a gap in the evidence related to the effects of patient and hospital characteristics on the outcomes of inpatients with chronic heart failure.

Method: This project was the first part of a larger study designed to investigate the prevalence and factors affecting inpatients hospitalized with CHF, using a longitudinal dataset from national inpatient samples. ICD 9 codes (CHF-428) were used for the extraction of the variables. This report focuses only on the descriptive characteristics of the sample patient population.

Results: The results showed that there were 697, 334 men and women hospitalized with chronic heart failure (46.88% male and 53.12% female, with an average age of 76.08 years). The ethnic distribution of patients were 74.64% White; 14.07% Black; 6.41% Hispanic; 1.72% Asian; 0.22% Native American; and 2.60% (other). The average LOS was 6.03 days with an average cost of $76,764 per patient, with a 94.88% survival rate after hospitalization.

Conclusion: These preliminary results indicate that patients hospitalized with chronic heart failure are primarily White, older, have lower household incomes, and exhibit diabetes as the major comorbidity, with approximately half of the patient admissions at urban teaching hospitals. These results may be helpful in identifying patterns in patient/ hospital characteristics which could lead to improved patient outcomes and lower re-hospitalization rates.

 

Keywords: Heart failure, hospitalization

Karavatas, S.G.1, Okunji, P.O.1, Enwerem, N.M.1, Fungwe, T.V.1, Ngwa, J.S.2, Obisesan, T.O.2, Greene, R.A1 Howard University; Washington, DC

1College of Nursing and Allied Health Sciences

2College of Medicine

CORRESPONDING AUTHOR: Spiridon (Spiro) G. Karavatas, PT, DPT, PhD, GCS Department of Physical Therapy College of Nursing and Allied Health Sciences Howard University 2041 Georgia Avenue, NW. HUH: 6W-47 Washington, DC 20060 USA Telephone: 202-865-2397; Email: skaravatas@howard.edu

 

 

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INTRODUCTION

There are approximately 5.1 million patients with chronic, or congestive, heart failure (CHF) in the United States accounting for 1 million hospital admissions, 6.5 million hospital days, and $37.2 billion in healthcare expenditure (Okunji et al., 2017). The costs are mainly derived from inpatient services, including length of stay (LOS) (Omar & Guglin, 2016a), with average cost of each episode of hospitalization estimated at $10,775 (Ziaeian, Sharma, Yu, Johnson, & Fonarow, 2015). The impetus has been to decrease length of stay (LOS) while improving patient outcomes (Omar & Guglin, 2016a). Highest costs were associated with urban and teaching hospitals, with LOS up to five times longer, nine times more expensive, and higher in-hospital mortality (5.6% vs 3.5%) when compared with lowest- cost hospitalizations (Ziaeian et al., 2015).

A multisite randomized trial of a multifaceted CHF patient-centered disease management (PCDM) intervention did not show improved patient health outcomes when compared with usual care (Bekelman et al., 2015). HF is associated with higher prevalence of C-Diff among hospitalized patients with common bacterial infections, even when adjusting for other C-Diff risk factors (Mamic, Heidenreich, Hedlin, Tennakoon, & Staudenmayer, 2016). Additionally, patients with CHF and C-Diff, had a significantly higher in-hospital mortality (Mamic et al., 2016). Among Medicare beneficiaries hospitalized for heart failure, 30-day all-cause readmission was associated with a higher risk of subsequent all-cause mortality, higher number of cumulative all-cause readmission, longer cumulative length of stay, and higher cumulative cost (Arundel et al., 2016).

Older patients with a median age of 72 years hospitalized with acute HF, had a higher prevalence of comorbidities, including hypertension and atrial fibrillation (Metra et al., 2015). Plasma urea nitrogen and hemoglobin levels were predictors of 90- days mortality in the younger patients, while respiratory rate and albumin levels were associated with 90- days mortality in the older patients (Metra et al., 2015). Extremely high BNP upon hospital admission is an independent risk factor of increased LOS and 6-month all-cause-mortality in HF (Omar & Guglin, 2016b). In patients with HF and reduced ejection fraction (HFrEF), anemia presents a higher risk of mortality and morbidity in patients who are male, older, with

renal dysfunction (Jonsson, Hallberg, Edner, Lund, & Dahlstrom, 2016). Dyspnea at rest is associated with higher 30-day mortality and HF readmission, longer length of stay, and higher health care costs compared with dyspnea with moderate activity (Mentz et al., 2015). Cognitive deficits in executive function, processing speed, and memory are common among older adults hospitalized patients with acute decompensated heart failure (ADHF) (Levin et al., 2014) . However, physicians do not routinely record cognitive changes (Dodson, Truong, Towle, Kerins, & Chaudhry, 2013). Recognition and documentation of these deficits is paramount for the clinical management of these high-risk patients (Dodson et al., 2013; Levin et al., 2014).

Women hospitalized with acute heart failure present differently than men, more often with preserved LVEF and higher rates of hypertension, diabetes, and depression. Diuretics were less intensively utilized in women than men; however, risk-adjusted 180-day post-hospital discharge outcomes were not different between men and women (Meyer et al., 2013). Data from Centers for Medicare & Medicaid Services beneficiaries hospitalized with HF indicate that socio- economic status (SES) characteristics have a modest association with post-discharge outcomes. Median household income was inversely associated with a 30- day mortality risk. When SES is not included in the model, Hispanics and African Americans had higher 30-day re-admission rates than Whites (Eapen et al., 2015; Vivo et al., 2014). Asians had similar rates with whites. However, when SES is included in the model, Hispanics and African Americans had modestly lower 30-day and 1-year mortality rates than Whites, but there were similar 30-day re-hospitalization rates among these ethnic groups (Eapen et al., 2015; Vivo et al., 2014). A recent randomized trial of 2331 patients, with chronic HF (CHF) and an ejection fraction (EF) ≤ 35, showed that compared to Whites, African-Americans patients (N=749) were younger, had lower SES, higher rates of hypertension and diabetes but less ischemic etiology (Mentz et al., 2013). Additionally, African Americans had increased prevalence of modifiable risk factors, lower exercise performance and higher rate of CHF related re- hospitalization, than Whites (Mentz et al., 2013).

There is an increase in the admission rates of congestive heart failure inpatients, and this prevalence

 

 

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continues with the longevity of baby boomers in the United States. Yet, there is a lack of current research on longitudinal patterns and associations of risk factors among congestive heart failure hospitalized patients with their health outcomes in non-federal hospitals. The purpose of this study was to examine the patient and hospital characteristics of patients with congestive heart failure (CHF) admitted into non-federal hospitals.

METHODS

This project was the first part of a larger study designed to investigate the prevalence and factors affecting inpatients hospitalized with CHF. Data from the National Inpatient Stay (NIS) Healthcare Cost and Utilization Project under the Agency for Healthcare Research and Quality (HCUP_AHRQ) were retrospectively analyzed from 2012 and 2013 hospital discharges for congestive heart failure patients ICD 9 code (CHF- 428). Statistical analysis using descriptive statistics were used to assess the patient and hospital characteristics of the sample. SAS version 9.3 (SAS Institute Inc. Cary, NC) was used to conduct the analysis.

RESULTS

The descriptive results showed that there were 697,334 men and women hospitalized with CHF (46.88% male & 53.12% female with a mean age of 76.08 years). By ethnicity, the patients were identified as 74.64% White; 14.07% Black; 6.41% Hispanic; 1.72% Asian; 0.22% Native American; and 2.60% (other). The mean LOS was six days, with an average cost of $76,764 per patient as 94.88% of the patients survived hospitalization. Table 1 highlights selected patient and hospital characteristics of the sample.

DISCUSSION

Preliminary descriptive results from the patient sample indicate that patients hospitalized with CHF are primarily older, white and a have lower household income. Diabetes is the major comorbidity, followed by obstructive sleep apnea and morbid obesity, with almost half of the CHF patients being admitted into

urban teaching hospitals. The results may be helpful in identifying patient and hospital characteristics which could lead to prevention, improved patient outcomes and lower re-hospitalization rates; however, these descriptive results only apply to this sample and cannot be generalized. Further inferential analysis of the data may identify important links between the patient and hospital characteristics which may lead to improved health status and quality of life for patients with CHF.

 

 

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TABLES

Table 1: Characteristics of Participants with CHF

Characteristics All Participants (N = 697334) Age – yrs. 76.08 (10.25)

Gender (%) Male 326,930 (46.88%)

Female 370,387 (53.12%) Race (%)

White (1) 495,848 (74.64%) Black (2) 93,469 (14.07%)

Hispanics (3) 42,598 (6.41%) Asian or Pacific Islander (4) 11,454 (1.72%)

Native Americans (5) 3,672 (0.55%) Others (6) 17,301 (2.60%)

Hospital Death Yes 35,682 (5.12%) No 661,531 (94.88%)

Length of Stay 6.03 (6.39) Total Charge 50,598 (76,764) Median Household Income

1 ($1 – $38,999) 222,708 (32.55%) 2 ($39,000 – $47,999) 173,518 (25.36%) 3 ($48,000 – $62,999) 156,933 (22.93%) 4 ($63,000 or More) 131,122 (19.16%)

Alzheimer’s Disease Status (%) 9,959 (2.86%) Renal Insufficiency (%) 22,496 (3.23%)

Diabetes (%) 204,497 (29.33%) Stroke (%) 11,082 (1.59%)

Morbid Obesity (%) 50,794(7.28%) Obstructive Sleep Apnea (%) 68,569 (9.83%)

Hospital Location Rural 98,901 (14.18%)

Urban Non-Teaching 274,847 (39.41%) Urban Teaching 323,586 (46.40%)

Values are Mean (SD) for Continuous Variables and Count (%) for Categorical Variables.

 

 

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