Most heart failure cases
discovered after hospital admittance
Newswise — About three out of four
people diagnosed at a hospital with congestive heart failure were
admitted for some other health condition, a new study found.
This finding surprised the
researchers and may have significant implications for patient
outcomes, medical costs and care.
People with secondary CHF – those
who were admitted to the hospital for another reason – were more
likely to die than were those diagnosed with primary CHF, incurred
more medical costs and spent more time in the hospital.
The study included a year’s worth
of inpatient records from more than 2.5 million people admitted to
350 hospitals in the United States. More than half a million of
these patients were diagnosed with CHF.
“We expected to see some patients
with secondary congestive heart failure, but we didn’t think that
the vast majority of congestive heart-failure cases would fall into
that category,” said Joseph Dasta, a study co-author and a professor
of pharmacy at Ohio State University.
Congestive heart failure is a
serious condition in which the heart doesn’t pump blood as
efficiently as it should, leading to a buildup of fluids in body
tissues.
Dasta and his colleagues presented
their findings in May in Washington, D.C., at the American Heart
Association’s Sixth Scientific Forum on Quality of Care and Outcomes
Research in Cardiovascular Disease and Stroke.
The researchers used a healthcare
database that contained information on patients admitted to 350
hospitals in the United States in 2003. They wanted to know what
resources were used to treat people with CHF as well as the costs
affiliated with treating those patients.
Of the 2.5 million people admitted
to the hospitals that year, one in five (20 percent, or 498,713) had
a CHF diagnosis. Of those, 73.7 percent (367,656) were diagnosed
with secondary CHF.
And the differences in treatment
costs and outcomes between the two groups – primary vs. secondary
CHF – are quite significant, said Amy Durtschi, a study co-author
and a clinical assistant professor of pharmacy at Ohio State.
On average, people with a
diagnosis of secondary CHF stayed in the hospital about three days
longer (9.5 days vs. 6.4 days) and their total hospital costs were
about $6,000 higher ($20,084 vs. $14,395.)
These patients were twice as
likely to die during their hospital stay – 8 percent of the people
with secondary CHF died, compared to 4.3 percent of the people with
primary CHF. Also, the people diagnosed with secondary CHF were more
likely to be discharged to a skilled nursing facility, rather than
being sent home.
The researchers say they aren’t
sure why three-quarters of heart failure patients are diagnosed with
secondary heart failure. But they speculate that it may have to do
with the difficulty of diagnosing heart failure along with other
diseases which are seen in heart failure patients, coupled with the
business and economic issues related to coding and hospital
outcomes.
For example, if a person is
admitted to a hospital twice in one month because of CHF, most
insurance companies won’t pay for a second diagnosis of primary CHF
in that same month, Durtschi said.
“So a physician may need to look
for another problem as the primary reason to admit the patient,” she
said. “Granted, if someone experiences congestive heart failure
twice in one month, he probably has other health problems, too.”
Dasta and Durtschi plan to take a
deeper look at the differences between primary and secondary CHF.
For one, they’d like to know if CHF combined with any kind of
diagnosis – regardless of whether CHF is primary or secondary –
drives up hospital and patient costs.
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