Healthcare use before first heart failure hospitalization: identifying opportunities to pre-emptively diagnose impending decompensation

Objectives — We sought to describe the pattern of healthcare contacts in patients ultimately presenting with incident hospitalization for acute heart failure (HF) compared with chronic obstructive pulmonary disease (COPD) exacerbation or stable HF.

Background — Little is known about how effectively HF is detected before the first acute hospitalization.

Methods — We compared 79,389 patients divided into 3 matched population cohorts in Ontario, Canada (2006–2013) with incident acute HF hospitalization, incident COPD hospitalization, or stable HF. The outcome of interest was the aggregate number of healthcare contacts occurring in each of the thirteen 28-day periods in the year preceding the index hospitalization. Healthcare contacts were defined as the total number of outpatient physician visits, hospitalizations for unrelated conditions, or emergency department visits.

Results — Acutely hospitalized patients with HF had a significant increase in healthcare contacts as time approached the index hospitalization. Patients with acute HF had a 28% increase in healthcare contacts in the last time period before the index hospitalization (adjusted rate ratio [RR]: 1.28; 95% confidence interval [CI]: 1.25 to 1.31; p < 0.001) compared with matched COPD controls. Compared with stable HF, acutely hospitalized patients had a 75% increase in healthcare contacts during the same time period (RR: 1.75; 95% CI: 1.71 to 1.79; p < 0.001). HF patients 20 to 40 years of age had an accelerated increase in the rate of healthcare contacts compared with those ≥65 years of age before index HF hospitalization (RR: 1.18; 95% CI: 1.08 to 1.28; p < 0.001).

Conclusions — Patients consulted physicians multiple times before their incident acute HF hospitalization. These healthcare contacts could represent missed opportunities to prevent hospitalizations for HF.