PMID- 20959343
OWN - NLM
STAT- MEDLINE
DCOM- 20110509
LR  - 20191210
IS  - 1879-0844 (Electronic)
IS  - 1388-9842 (Linking)
VI  - 13
IP  - 2
DP  - 2011 Feb
TI  - Trends in heart failure care: has the incident diagnosis of heart failure shifted 
      from the hospital to the emergency department and outpatient clinics?
PG  - 142-7
LID - 10.1093/eurjhf/hfq185 [doi]
AB  - AIMS: Studies of heart failure (HF) incidence and prevalence frequently rely on 
      hospitalization to identify patients. Our objective was to describe the 
      incidence, prevalence, or outcomes for HF patients diagnosed in the outpatient or 
      emergency department (ED) setting. METHODS AND RESULTS: In a population-based 
      study of 82,323 HF patients in a single-payer health-care system in Alberta, 
      Canada from 1999 to 2007, we examined trends over time and clinical outcomes. 
      Heart failure patients were first diagnosed in a general outpatient clinic 
      (45.7%), a specialty outpatient clinic (4.0%), the ED (13.7%), or in hospital 
      (36.6%). From years 2000 to 2006, the age-standardized incidence (per 100 000 
      population) decreased from 538 to 403, whereas the overall prevalence increased 
      from 1585 to 2510. One-year mortality was significantly different among patients 
      first diagnosed in a general outpatient clinic (6.6%), a specialty outpatient 
      clinic (7.5%), ED (19.1%), and hospital (29.8%). Patients initially diagnosed at 
      the time of hospitalization had the fewest median days alive and out of hospital 
      [347, inter-quartile range (IQR): 136-363] over the next year compared with 
      patients in the ED (354, IQR 313-365), specialty outpatient clinic (365, IQR 
      355-365), and general outpatient clinics (365, IQR: 359-365, P < 0.0001). 
      Patients in the ED had the highest rate of subsequent ED visits, and all-cause, 
      cardiovascular, or HF hospitalization. CONCLUSIONS: Over time, more patients were 
      diagnosed as outpatients compared with a hospital setting. The trends observed in 
      incidence, prevalence, and outcomes for patients with HF differ substantially 
      depending on the location of initial diagnosis. Additionally, efforts to study 
      patients with HF in the ED should be a priority.
FAU - Ezekowitz, Justin A
AU  - Ezekowitz JA
AD  - Division of Cardiology 2C2 WMC, Mazankowski Alberta Heart Institute, University 
      of Alberta, Edmonton, AB, Canada. justin.ezekowitz@ualberta.ca
FAU - Kaul, Padma
AU  - Kaul P
FAU - Bakal, Jeffrey A
AU  - Bakal JA
FAU - Quan, Hude
AU  - Quan H
FAU - McAlister, Finlay A
AU  - McAlister FA
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20101019
PL  - England
TA  - Eur J Heart Fail
JT  - European journal of heart failure
JID - 100887595
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Alberta/epidemiology
MH  - Ambulatory Care/trends
MH  - Ambulatory Care Facilities/*statistics & numerical data/trends
MH  - Analysis of Variance
MH  - Cohort Studies
MH  - Confidence Intervals
MH  - Emergency Service, Hospital/*statistics & numerical data/trends
MH  - Female
MH  - Follow-Up Studies
MH  - Forecasting
MH  - Heart Failure/*diagnosis/*epidemiology/therapy
MH  - Hospitalization/*statistics & numerical data/trends
MH  - Humans
MH  - Incidence
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Outcome Assessment, Health Care
MH  - Prevalence
MH  - Proportional Hazards Models
MH  - Registries
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Statistics, Nonparametric
MH  - Survival Analysis
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2010/10/21 06:00
MHDA- 2011/05/10 06:00
CRDT- 2010/10/21 06:00
PHST- 2010/10/21 06:00 [entrez]
PHST- 2010/10/21 06:00 [pubmed]
PHST- 2011/05/10 06:00 [medline]
AID - hfq185 [pii]
AID - 10.1093/eurjhf/hfq185 [doi]
PST - ppublish
SO  - Eur J Heart Fail. 2011 Feb;13(2):142-7. doi: 10.1093/eurjhf/hfq185. Epub 2010 Oct 
      19.