RT Journal Article
SR Electronic
T1 Survival and health economic outcomes in heart failure diagnosed at hospital admission versus community settings: a propensity-matched analysis
JF BMJ Health & Care Informatics
JO BMJ Health Care Inform
FD BMJ Publishing Group Ltd
SP e100718
DO 10.1136/bmjhci-2022-100718
VO 30
IS 1
A1 Patrik Bachtiger
A1 Mihir A Kelshiker
A1 Camille F Petri
A1 Manisha Gandhi
A1 Moulesh Shah
A1 Tahereh Kamalati
A1 Samir Ali Khan
A1 Gareth Hooper
A1 Jon Stephens
A1 Abdullah Alrumayh
A1 Carys Barton
A1 Daniel B Kramer
A1 Carla M Plymen
A1 Nicholas S Peters
YR 2023
UL http://informatics.bmj.com/content/30/1/e100718.abstract
AB Background and aims Most patients with heart failure (HF) are diagnosed following a hospital admission. The clinical and health economic impacts of index HF diagnosis made on admission to hospital versus community settings are not known.Methods We used the North West London Discover database to examine 34 208 patients receiving an index diagnosis of HF between January 2015 and December 2020. A propensity score-matched (PSM) cohort was identified to adjust for differences in socioeconomic status, cardiovascular risk and pre-diagnosis health resource utilisation cost. Outcomes were stratified by two pathways to index HF diagnosis: a ‘hospital pathway’ was defined by diagnosis following hospital admission; and a ‘community pathway’ by diagnosis via a general practitioner or outpatient services. The primary clinical and health economic endpoints were all-cause mortality and cost-consequence differential, respectively.Results The diagnosis of HF was via hospital pathway in 68% (23 273) of patients. The PSM cohort included 17 174 patients (8582 per group) and was matched across all selected confounders (p>0.05). The ratio of deaths per person-months at 24 months comparing community versus hospital diagnosis was 0.780 (95% CI 0.722 to 0.841, p<0.0001). By 72 months, the ratio of deaths was 0.960 (0.905 to 1.020, p=0.18). Diagnosis via hospital pathway incurred an overall extra longitudinal cost of £2485 per patient.Conclusions Index diagnosis of HF through hospital admission continues to dominate and is associated with a significantly greater short-term risk of mortality and substantially increased long-term costs than if first diagnosed in the community. This study highlights the potential for community diagnosis—early, before symptoms necessitate hospitalisation—to improve both clinical and health economic outcomes.Data are available upon reasonable request.