TY - JOUR
T1 - Importance of diagnostic setting in determining mortality in patients with new-onset heart failure
T2 - temporal trends in Denmark from 1997 to 2017
AU - Arulmurugananthavadivel, Anojhaan
AU - Holt, Anders
AU - Parveen, Saaima
AU - Lamberts, Morten
AU - Gislason, Gunnar H.
AU - Torp-Pedersen, Christian
AU - Madelaire, Christian
AU - Andersson, Charlotte
AU - Zahir, Deewa
AU - Butt, Jawad H.
AU - Petrie, Mark C.
AU - McMurray, John
AU - Fosbol, Emil L.
AU - Kober, Lars
AU - Schou, Morten
N1 - © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2022/11
Y1 - 2022/11
N2 - AIM: To investigate temporal trends in inpatient vs. outpatient diagnosis of new-onset heart failure (HF) and the subsequent risk of death and hospitalization.METHODS AND RESULTS: Using nationwide registers, 192 581 patients with a first diagnosis of HF (1997-2017) were included. We computed incidences of HF, age-standardized mortality rates, and absolute risks (ARs) of death and hospitalization (accounting for competing risk of death) to understand the importance of the diagnosis setting in relation to subsequent mortality and hospitalization. The overall incidence of HF was approximately the same (170/100 000 persons) every year during 1997-2017. However, in 1997, 77% of all first diagnoses of HF were made during a hospitalization, whereas the proportion was 39% in 2017. As inpatient diagnoses decreased, outpatient diagnoses increased from 23% to 61%. Outpatients had lower mortality and hospitalization rates than inpatients throughout the study period, although the 1-year age-standardized mortality rate decreased for each inpatient (24 to 14/100-person) and outpatient (11 to 7/100-person). One-year and five-year AR of death decreased by 11.1% and 17.0%, respectively, for all HF patients, while the risk of hospitalization for HF did not decrease significantly (1.13% and 0.96%, respectively).CONCLUSION: Between 1997 and 2017, HF changed from being primarily diagnosed during hospitalization to being mostly diagnosed in the outpatient setting. Outpatients had much lower mortality rates than inpatients throughout the study period. Despite a significant decrease in mortality risk for all HF patients, neither inpatients nor outpatients experienced a reduction in the risk of an HF hospitalization.
AB - AIM: To investigate temporal trends in inpatient vs. outpatient diagnosis of new-onset heart failure (HF) and the subsequent risk of death and hospitalization.METHODS AND RESULTS: Using nationwide registers, 192 581 patients with a first diagnosis of HF (1997-2017) were included. We computed incidences of HF, age-standardized mortality rates, and absolute risks (ARs) of death and hospitalization (accounting for competing risk of death) to understand the importance of the diagnosis setting in relation to subsequent mortality and hospitalization. The overall incidence of HF was approximately the same (170/100 000 persons) every year during 1997-2017. However, in 1997, 77% of all first diagnoses of HF were made during a hospitalization, whereas the proportion was 39% in 2017. As inpatient diagnoses decreased, outpatient diagnoses increased from 23% to 61%. Outpatients had lower mortality and hospitalization rates than inpatients throughout the study period, although the 1-year age-standardized mortality rate decreased for each inpatient (24 to 14/100-person) and outpatient (11 to 7/100-person). One-year and five-year AR of death decreased by 11.1% and 17.0%, respectively, for all HF patients, while the risk of hospitalization for HF did not decrease significantly (1.13% and 0.96%, respectively).CONCLUSION: Between 1997 and 2017, HF changed from being primarily diagnosed during hospitalization to being mostly diagnosed in the outpatient setting. Outpatients had much lower mortality rates than inpatients throughout the study period. Despite a significant decrease in mortality risk for all HF patients, neither inpatients nor outpatients experienced a reduction in the risk of an HF hospitalization.
KW - Denmark/epidemiology
KW - Heart Failure
KW - Hospitalization
KW - Humans
KW - Incidence
KW - Inpatients
KW - Heart failure
KW - Prognosis
KW - Inpatient
KW - Outpatient
KW - Temporal trend
UR - http://www.scopus.com/inward/record.url?scp=85136049313&partnerID=8YFLogxK
U2 - 10.1093/ehjqcco/qcab073
DO - 10.1093/ehjqcco/qcab073
M3 - Journal article
C2 - 34625809
SN - 2058-1742
VL - 8
SP - 750
EP - 760
JO - European heart journal. Quality of care & clinical outcomes
JF - European heart journal. Quality of care & clinical outcomes
IS - 7
M1 - qcab073
ER -