Document Detail


Factors associated with increased hospital utilization in patients with heart failure and preserved ejection fraction.
MedLine Citation:
PMID:  20575629     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: To determine whether controlling systolic blood pressure (SBP), pulse pressure, and heart rate in the outpatient setting is associated with decreased hospital utilization in patients with heart failure and preserved ejection fraction (PEF). DESIGN: Retrospective medical record review. SETTING: University-affiliated medical center and outpatient clinics. PATIENTS: One hundred forty adults admitted between January 1, 2003, and October 31, 2005, for an exacerbation of heart failure with PEF and followed for 2 years after their index admission. MEASUREMENTS AND MAIN RESULTS: Outpatient SBP, pulse pressure, and heart rate, and the percentage of clinic visits for which patients had each vital sign at a certain level were used for correlations and comparisons. These vital signs and percentages of clinic visits were varied until maximum significant differences were observed in total hospital utilization for each parameter. These values were then analyzed for differences based on age, race-ethnicity, and sex. When comparing patients whose vital signs were in control for at least 80% of clinic visits versus those whose were in control for less than 80% of clinic visits, significantly lower hospital utilization was associated with clinic SBP less than 140 mm Hg (median hospital utilization 3 vs 5 visits, p=0.0252), pulse pressure less than 65 mm Hg (3 vs 5 visits, p=0.0113), and heart rate of 55-70 beats/minute (2 vs 4 visits, p=0.0311). Among the 140 patients, 78 (56%) were Caucasian, 48 (34%) were Hispanic, and 14 (10%) were African-American. The African-American patients were significantly younger (p=0.0218) and had significantly poorer SBP control (< 140 mm Hg for >/= 80% of clinic visits: 14.3% vs 43.8%, p=0.0446) and higher hospital utilization (> 4 visits: 78.6% vs 43.8%, p=0.0218) than the Hispanic patients, despite similar percentages of missed clinic appointments (25% for each group). CONCLUSION: Controlling SBP at less than 140 mm Hg, pulse pressure at less than 65 mm Hg, and heart rate at 55-70 beats/minute for at least 80% of clinic visits were factors associated with decreased hospital utilization. African-American patients with heart failure and PEF were younger, had more poorly controlled SBP, and had higher hospital utilization despite similar percentage of missed clinic visits as their Hispanic counterparts.
Authors:
Rachel S Crowder; Brian K Irons; Gary Meyerrose; Charles F Seifert
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pharmacotherapy     Volume:  30     ISSN:  1875-9114     ISO Abbreviation:  Pharmacotherapy     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-06-25     Completed Date:  2010-10-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8111305     Medline TA:  Pharmacotherapy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  646-53     Citation Subset:  IM    
Affiliation:
University Medical Center, Texas Tech University Health Sciences Center, Lubbock, Texas 79430-8162, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
African Americans
Ambulatory Care Facilities
Blood Pressure / drug effects*
Continental Population Groups
Female
Heart Failure / drug therapy*
Hispanic Americans
Humans
Male
Patient Compliance
Retrospective Studies
Treatment Outcome
Vital Signs

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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