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Heart Failure Usually Discovered After Patients
Admitted for Something Else
June 2, 2005 - About three out of four people
diagnosed at a hospital with congestive heart failure were admitted for
some other health condition, a new study found. This finding surprised
the researchers and may have significant implications for patient
outcomes, medical costs and care.
People with secondary CHF those who were admitted
to the hospital for another reason were more likely to die than were
those diagnosed with primary CHF, incurred more medical costs and spent
more time in the hospital.
The study included a year's worth of inpatient
records from more than 2.5 million people admitted to 350 hospitals in
the United States . More than half a million of these patients were
diagnosed with CHF.
We expected to see some patients with secondary
congestive heart failure, but we didn't think that the vast majority of
congestive heart-failure cases would fall into that category, said
Joseph Dasta, a study
co-author and a professor of
pharmacy at Ohio State University
.
Congestive heart failure is a
serious condition in which the heart doesn't pump blood as efficiently
as it should, leading to a buildup of fluids in body tissues.
Dasta and his colleagues presented their findings
in May in Washington , D.C. , at the
American Heart Association's Sixth
Scientific Forum on Quality of Care and Outcomes Research in
Cardiovascular Disease and Stroke.
The researchers used a healthcare database that
contained information on patients admitted to 350 hospitals in the
United States in 2003. They wanted to know what resources were used to
treat people with CHF as well as the costs affiliated with treating
those patients.
Of the 2.5 million people admitted to the hospitals that year, one in
five (20 percent, or 498,713) had a CHF diagnosis. Of those, 73.7
percent (367,656) were diagnosed with secondary CHF.
And the differences in treatment costs and outcomes
between the two groups primary vs. secondary CHF are quite
significant, said Amy Durtschi, a study co-author and a clinical
assistant professor of pharmacy at Ohio State .
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The researchers say they aren't sure why
three-quarters of heart failure patients are diagnosed with
secondary heart failure. But they speculate that it may have to
do with the difficulty of diagnosing heart failure along with
other diseases which are seen in heart failure patients, coupled
with the business and economic issues related to coding and
hospital outcomes.
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On average, people with a diagnosis of secondary
CHF stayed in the hospital about three days longer (9.5 days vs. 6.4
days) and their total hospital costs were about $6,000 higher ($20,084
vs. $14,395.)
These patients were twice as likely to die during
their hospital stay 8 percent of the people with secondary CHF died,
compared to 4.3 percent of the people with primary CHF. Also, the people
diagnosed with secondary CHF were more likely to be discharged to a
skilled nursing facility, rather than being sent home.
The researchers say they aren't sure why
three-quarters of heart failure patients are diagnosed with secondary
heart failure. But they speculate that it may have to do with the
difficulty of diagnosing heart failure along with other diseases which
are seen in heart failure patients, coupled with the business and
economic issues related to coding and hospital outcomes.
For example, if a person is admitted to a hospital
twice in one month because of CHF, most insurance companies won't pay
for a second diagnosis of primary CHF in that same month, Durtschi said.
So a physician may need to look for another
problem as the primary reason to admit the patient, she said. Granted,
if someone experiences congestive heart failure twice in one month, he
probably has other health problems, too.
Dasta and Durtschi plan to take a deeper look at
the differences between primary and secondary CHF. For one, they'd like
to know if CHF combined with any kind of diagnosis regardless of
whether CHF is primary or secondary drives up hospital and patient
costs.
The researchers received financial support from
Abbott Laboratories, Abbott
Park, Ill. Abbott Laboratories paid for the services performed by
NDC Health, the company that
owns the database the researchers used.
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