Document Detail


Changes in Heart Failure Outcomes after a Province-Wide Change in Health Service Provision: A Natural Experiment in Alberta, Canada.
MedLine Citation:
PMID:  23230308     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: -The Alberta Cardiac Access [ACA] initiative was implemented in the spring of 2008 to increase access to specialized heart failure (HF) clinics after hospital discharge. METHODS AND RESULTS: -We identified all adults hospitalized with a most responsible diagnosis of HF between April 1999 and December 2009. We randomly selected one episode of care per patient and evaluated outcomes using interrupted time series: the a priori specified primary outcome was "all-cause readmission or death in the first 30 days post-discharge". Between 1999 and 2009, median length of stay increased from 8 days to 10 days (p<0.001) and 30 day mortality increased from 9.1% to 11.5% (p<0.001) in the 37 891 HF hospitalizations we examined. However, these temporal changes were attributable to the increasing comorbidity burden over time: the adjusted Risk Ratio (aRR) for 30 day mortality in 2009 vs. 1999 was 0.99, 95% CI 0.86-1.15. After adjusting for secular trends, the ACA initiative was associated with changes in 30 day post-discharge mortality or readmission rates (which were increasing 0.3% per month [0.2%-0.3%] pre-ACA and decreased 1.4% per month [0.3%-2.5%] in the 18 months post-ACA, p=0.008). After roll out of the ACA initiative, patients discharged from vanguard regions (those that had specialized HF clinics) exhibited lower 30 day post-discharge death/readmission rates than those discharged from other areas of the province (18.6% vs. 22.2%, adjusted OR 0.83, 95% CI 0.75-0.93). CONCLUSIONS: -An initiative which increased specialized HF clinic access was associated with a statistically significant improvement in 30 day post-discharge mortality/readmission rates.
Authors:
Finlay A McAlister; Jeffrey A Bakal; Padma Kaul; Hude Quan; Robyn Blackadar; David Johnstone; Justin A Ezekowitz
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-10
Journal Detail:
Title:  Circulation. Heart failure     Volume:  -     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1 University of Alberta, Edmonton, Canada;
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