| Changes in Heart Failure Outcomes after a Province-Wide Change in Health Service Provision: A Natural Experiment in Alberta, Canada. | |
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MedLine Citation:
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PMID: 23230308 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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. |
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Authors:
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Finlay A McAlister; Jeffrey A Bakal; Padma Kaul; Hude Quan; Robyn Blackadar; David Johnstone; Justin A Ezekowitz |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-12-10 |
Journal Detail:
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Title: Circulation. Heart failure Volume: - ISSN: 1941-3297 ISO Abbreviation: Circ Heart Fail Publication Date: 2012 Dec |
Date Detail:
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Created Date: 2012-12-11 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101479941 Medline TA: Circ Heart Fail Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1 University of Alberta, Edmonton, Canada; |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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