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Haywood HB, Graham AJ, Chermak D, Achanta A, Butler J, Fonarow GC, Greene SJ. Estimating the Proportion of Heart Failure Admissions Potentially Eligible for Hospital at Home. J Card Fail 2024; 30:1060-1062. [PMID: 38588859 DOI: 10.1016/j.cardfail.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/27/2024] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Affiliation(s)
- Hubert B Haywood
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Aubrey Jolly Graham
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC
| | | | - Aditya Achanta
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX; Department of Medicine, University of Mississippi, Jackson, MI
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles, Los Angeles, CA
| | - Stephen J Greene
- Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC..
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Rothman RD, Delaney CP, Heaton BM, Hohman JA. Early experience and lessons following the implementation of a Hospital-at-Home program. J Hosp Med 2024; 19:744-748. [PMID: 38326732 DOI: 10.1002/jhm.13293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/07/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Richard D Rothman
- Cleveland Clinic Florida, Weston, Florida, USA
- Cleveland Clinic, Integrated Hospital Care Institute, Cleveland, Ohio, USA
| | | | - Britney M Heaton
- Cleveland Clinic Florida, Weston, Florida, USA
- Cleveland Clinic, Integrated Hospital Care Institute, Cleveland, Ohio, USA
| | - Jessica A Hohman
- Cleveland Clinic, Primary Care Institute and the Cleveland Clinic Center for Value-Based Care Research, Cleveland, Ohio, USA
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Gustafson SE, Hamilton SA, Ambrosy AP. In Search of a Timely, Safe, and Effective Alternative to Hospitalization for Heart Failure. JAMA Netw Open 2024; 7:e2350454. [PMID: 38198144 DOI: 10.1001/jamanetworkopen.2023.50454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Affiliation(s)
- Shanshan E Gustafson
- Department of Medicine, Kaiser Permanente Mid-Atlantic Medical Group, Gaithersburg, Maryland
| | - Steven A Hamilton
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Andrew P Ambrosy
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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Achanta A, Wasfy JH, Moss CT, Cherukara A, Ho D, Boxer R, Schmieding M, Phadke NA, Thompson R, Levine DM, Weiner RB. Home Hospital Outcomes for Acute Decompensated Heart Failure and Factors Associated With Escalation of Care. Circ Cardiovasc Qual Outcomes 2024; 17:e010031. [PMID: 38054286 DOI: 10.1161/circoutcomes.123.010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/24/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Overall outcomes and the escalation rate for home hospital admissions for heart failure (HF) are not known. We report overall outcomes, predict escalation, and describe care provided after escalation among patients admitted to home hospital for HF. METHODS Our retrospective analysis included all patients admitted for HF to 2 home hospital programs in Massachusetts between February 2020 and October 2022. Escalation of care was defined as transfer to an inpatient hospital setting (emergency department, inpatient medical unit) for at least 1 overnight stay. Unexpected mortality was defined as mortality excluding those who desired to pass away at home on admission or transitioned to hospice. We performed the least absolute shrinkage and selection operator logistic regression to predict escalation. RESULTS We included 437 hospitalizations; patients had a median age of 80 (interquartile range, 69-89) years, 58.1% were women, and 64.8% were White. Of the cohort, 29.2% had reduced ejection fraction, 50.9% had chronic kidney disease, and 60.6% had atrial fibrillation. Median admission Get With The Guidelines HF score was 39 (interquartile range, 35-45; 1%-5% predicted inpatient mortality). Escalation occurred in 10.3% of hospitalizations. Thirty-day readmission occurred in 15.1%, 90-day readmission occurred in 33.8%, and 6-month mortality occurred in 11.5%. There was no unexpected mortality during home hospitalization. Patients who experienced escalation had significantly longer median length of stays (19 versus 7.5 days, P<0.001). The most common reason for escalation was progressive renal dysfunction (36.2%). A low mean arterial pressure at the time of admission to home hospital was the most significant predictor of escalation in the least absolute shrinkage and selection operator regression. CONCLUSIONS About 1 in 10 home hospital patients with HF required escalation; none had unexpected mortality. Patients requiring escalation had longer length of stays. A low mean arterial pressure at the time of admission to home hospital was the most important predictor of escalation of care in the least absolute shrinkage and selection operator logistic regression model.
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Affiliation(s)
- Aditya Achanta
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Jason H Wasfy
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
- Cardiology Division (J.H.W., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
| | | | | | - David Ho
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Robert Boxer
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Malte Schmieding
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Neelam Ameya Phadke
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
- Allergy and Immunology Division (N.P.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Ryan Thompson
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - David Michael Levine
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital and Harvard Medical School, Boston, MA (A.C., D.H., R.B., M.S., D.L.)
| | - Rory B Weiner
- Department of Medicine (A.A., J.H.W., N.P., R.T., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
- Cardiology Division (J.H.W., R.B.W.), Massachusetts General Hospital and Harvard Medical School, Boston
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