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Teaching Hospitalists Might Provide Lessons on Optimizing Heart Failure Outcomes
The 18th Annual Scientific Meeting
HFSA
S51
analyses. Most of the observed costs (78%) and LOS (75%) occurred on the index hospitalization and drove the cumulative results. A similar trend was found even when excluding those who died at the index hospitalization. Conclusion: Patients with transient increases in SCr were more likely to experience longer cumulative LOS and higher costs than those without WRF or WRF which persisted until discharge. Further research is needed to investigate the causes and implications of the markedly prolonged LOS and increased costs associated with WRFt patients.
Figure 2.
Figure.
125 Teaching Hospitalists Might Provide Lessons on Optimizing Heart Failure Outcomes Paul M. Ndunda, Mohamoud Farhoud, James Kallail, Hussam Farhoud; Kansas University School of Medicine-Wichita, Wichita, KS Background: Studies have evaluated the utility of the hospitalist model in the management of heart failure patients. However data is lacking on the outcomes among patients hospitalized to teaching hospitalist services compared to other physician categories. Objective: To determine the clinical outcomes of hospitalized heart failure patients under the care of different physician categories. Methods: We conducted a retrospective cohort study of 1735 adult patients hospitalized for heart failure over two years in three community hospitals in the United States. We compared the clinical outcomes by 3 teaching hospitalist groups, non-teaching hospitalist groups, cardiologists, nephrologists and community primary care physicians (PCPs). Outcome measures included: in-hospital mortality, 30-day readmission rates, hospital length of stay and rates of discharge to different disposition destinations. Results: The teaching hospitalists had the lowest in-hospital mortality rate (0.94%, p!0.05). The average length of stay was significantly shorter with the teaching hospitalists and non-teaching hospitalists (5.2 and 5.3 days respectively) compared with the other physician categories (p !0.05). The teaching hospitalists had a significantly lower
Figure 1.
30-day disease-specific readmission rate (3.3%, p!0.05) compared to Cardiologists, PCPs and non-teaching hospitalists. A higher proportion of patients was discharged home by the teaching hospitalists (79%, p!0.05) compared with the other physician categories. Conclusion: Patients admitted by teaching hospitalists had the lowest mortality rates, average length of stay, and had a higher proportion discharged home compared to other physician categories. There is need for studies to determine factors that may explain the differences in outcomes and to provide lessons on how to improve clinical outcomes of hospitalized heart failure patients.
126 Characterization and Prediction of Adverse Events from Intensive Chronic Heart Failure Management with and without NT-proBNP Guidance: Results from the ProBNP Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) Study Parul U. Gandhi1, Jackie Szymonifka2, Shweta R. Motiwala3, Arianna S. Belcher1, James L. Januzzi1, Hanna K. Gaggin1; 1Massachusetts General Hospital, Boston, MA; 2Massachusetts General Hospital, Boston, MA; 3Beth Israel Deaconess Medical Center, Boston, MA Introduction: Serious adverse events (SAE) from heart failure (HF) therapy are frequent; however, techniques to identify patients who are at risk have not been investigated. Furthermore, the effects of SAE on quality of life (QOL) and cardiac structure are unknown. Hypothesis: Patients who experience treatment-related SAE will have differing characteristics compared to those who do not. Treatment-related SAEs will have an adverse effect on QOL and cardiac structure. NT-proBNP guided HF therapy will not be associated with greater incidence of treatment-related SAE. Methods: In this post hoc analysis, 151 patients with HF (New York Heart Association [NYHA] Class II-IV) and ejection fraction (EF) #40% were followed for a mean of 10 months. At each visit, patients underwent laboratory testing, physical exam, and completed the Minnesota Living with HF questionnaire (MLHFQ).
Figure.
HFSA
S51
analyses. Most of the observed costs (78%) and LOS (75%) occurred on the index hospitalization and drove the cumulative results. A similar trend was found even when excluding those who died at the index hospitalization. Conclusion: Patients with transient increases in SCr were more likely to experience longer cumulative LOS and higher costs than those without WRF or WRF which persisted until discharge. Further research is needed to investigate the causes and implications of the markedly prolonged LOS and increased costs associated with WRFt patients.
Figure 2.
Figure.
125 Teaching Hospitalists Might Provide Lessons on Optimizing Heart Failure Outcomes Paul M. Ndunda, Mohamoud Farhoud, James Kallail, Hussam Farhoud; Kansas University School of Medicine-Wichita, Wichita, KS Background: Studies have evaluated the utility of the hospitalist model in the management of heart failure patients. However data is lacking on the outcomes among patients hospitalized to teaching hospitalist services compared to other physician categories. Objective: To determine the clinical outcomes of hospitalized heart failure patients under the care of different physician categories. Methods: We conducted a retrospective cohort study of 1735 adult patients hospitalized for heart failure over two years in three community hospitals in the United States. We compared the clinical outcomes by 3 teaching hospitalist groups, non-teaching hospitalist groups, cardiologists, nephrologists and community primary care physicians (PCPs). Outcome measures included: in-hospital mortality, 30-day readmission rates, hospital length of stay and rates of discharge to different disposition destinations. Results: The teaching hospitalists had the lowest in-hospital mortality rate (0.94%, p!0.05). The average length of stay was significantly shorter with the teaching hospitalists and non-teaching hospitalists (5.2 and 5.3 days respectively) compared with the other physician categories (p !0.05). The teaching hospitalists had a significantly lower
Figure 1.
30-day disease-specific readmission rate (3.3%, p!0.05) compared to Cardiologists, PCPs and non-teaching hospitalists. A higher proportion of patients was discharged home by the teaching hospitalists (79%, p!0.05) compared with the other physician categories. Conclusion: Patients admitted by teaching hospitalists had the lowest mortality rates, average length of stay, and had a higher proportion discharged home compared to other physician categories. There is need for studies to determine factors that may explain the differences in outcomes and to provide lessons on how to improve clinical outcomes of hospitalized heart failure patients.
126 Characterization and Prediction of Adverse Events from Intensive Chronic Heart Failure Management with and without NT-proBNP Guidance: Results from the ProBNP Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) Study Parul U. Gandhi1, Jackie Szymonifka2, Shweta R. Motiwala3, Arianna S. Belcher1, James L. Januzzi1, Hanna K. Gaggin1; 1Massachusetts General Hospital, Boston, MA; 2Massachusetts General Hospital, Boston, MA; 3Beth Israel Deaconess Medical Center, Boston, MA Introduction: Serious adverse events (SAE) from heart failure (HF) therapy are frequent; however, techniques to identify patients who are at risk have not been investigated. Furthermore, the effects of SAE on quality of life (QOL) and cardiac structure are unknown. Hypothesis: Patients who experience treatment-related SAE will have differing characteristics compared to those who do not. Treatment-related SAEs will have an adverse effect on QOL and cardiac structure. NT-proBNP guided HF therapy will not be associated with greater incidence of treatment-related SAE. Methods: In this post hoc analysis, 151 patients with HF (New York Heart Association [NYHA] Class II-IV) and ejection fraction (EF) #40% were followed for a mean of 10 months. At each visit, patients underwent laboratory testing, physical exam, and completed the Minnesota Living with HF questionnaire (MLHFQ).
Figure.