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Differentiation of clinical characteristics, mortality, healthcare utilization and costs among four subgroups in a population with heart failure

Davidge, Jason Troy LU (2024) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Heart failure (HF) is associated with high mortality, decreased quality of life,
and places a heavy burden on healthcare resources. Numerous HF patients are
diagnosed without a conclusive echocardiogram and are lacking appropriate
pharmacotherapy. The majority of HF studies in Sweden are based on hospital
registries that may not represent the entirety of the HF patient population. This
thesis examined HF patients in Region Halland (RH), Sweden, using an
unselected, community-based cohort, and determined factors associated with
mortality, morbidity and healthcare costs.
Data regarding clinical characteristics and pharmacotherapy were retrieved
from the Regional Healthcare Information Platform in... (More)
Heart failure (HF) is associated with high mortality, decreased quality of life,
and places a heavy burden on healthcare resources. Numerous HF patients are
diagnosed without a conclusive echocardiogram and are lacking appropriate
pharmacotherapy. The majority of HF studies in Sweden are based on hospital
registries that may not represent the entirety of the HF patient population. This
thesis examined HF patients in Region Halland (RH), Sweden, using an
unselected, community-based cohort, and determined factors associated with
mortality, morbidity and healthcare costs.
Data regarding clinical characteristics and pharmacotherapy were retrieved
from the Regional Healthcare Information Platform in Halland County. We
applied a novel algorithm which extracted all available EF values for HF
patients in RH, providing a real-world cohort for further study. Those without
a conclusive echocardiogram, in which no defined phenotype could be
deduced, were categorized as a fourth HF subgroup (HF-NDP).
A conclusive EF value was determined in 57% of cases and the distribution of
HF phenotypes varied from those in registry-based studies. Of patients
admitted to hospital due to HF symptoms, 1644 (33%) were readmitted with a
CVD diagnosis within 100 days. Nearly half (43%) of the cohort was
diagnosed clinically, the majority of these (58%) being diagnosed in hospital,
which also carried a higher one-year mortality compared to those diagnosed in
primary care. Healthcare encounters and costs were higher for all subgroups in
the first year, decreasing in the second year to varying degrees.
These papers provide an in-depth examination of a real-world HF patient
population. Mortality was highest among patients diagnosed clinically, while
those with a combination of recommended medications, generally lacking in
the cohort, showed a decreased risk of readmission. The results underline the
importance of correct diagnostic procedure and treatment to reduce morbidity,
mortality and healthcare costs. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Östgren, Carl-Johan, University of Linköping
organization
publishing date
type
Thesis
publication status
published
subject
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2024:109
pages
96 pages
publisher
Lund University, Faculty of Medicine
defense location
Agardh föreläsningssal, CRC, Jan Waldenströms gata 35, Skånes Universitetssjukhus i Malmö
defense date
2024-09-20 13:00:00
ISSN
1652-8220
ISBN
978-91-8021-605-0
language
English
LU publication?
yes
id
9c5d3029-8e35-4694-b33d-0e680104d84b
date added to LUP
2024-08-28 12:37:44
date last changed
2025-04-04 15:15:51
@phdthesis{9c5d3029-8e35-4694-b33d-0e680104d84b,
  abstract     = {{Heart failure (HF) is associated with high mortality, decreased quality of life, <br/>and places a heavy burden on healthcare resources. Numerous HF patients are <br/>diagnosed without a conclusive echocardiogram and are lacking appropriate <br/>pharmacotherapy. The majority of HF studies in Sweden are based on hospital <br/>registries that may not represent the entirety of the HF patient population. This <br/>thesis examined HF patients in Region Halland (RH), Sweden, using an <br/>unselected, community-based cohort, and determined factors associated with <br/>mortality, morbidity and healthcare costs. <br/>Data regarding clinical characteristics and pharmacotherapy were retrieved <br/>from the Regional Healthcare Information Platform in Halland County. We <br/>applied a novel algorithm which extracted all available EF values for HF <br/>patients in RH, providing a real-world cohort for further study. Those without <br/>a conclusive echocardiogram, in which no defined phenotype could be <br/>deduced, were categorized as a fourth HF subgroup (HF-NDP). <br/>A conclusive EF value was determined in 57% of cases and the distribution of <br/>HF phenotypes varied from those in registry-based studies. Of patients <br/>admitted to hospital due to HF symptoms, 1644 (33%) were readmitted with a <br/>CVD diagnosis within 100 days. Nearly half (43%) of the cohort was <br/>diagnosed clinically, the majority of these (58%) being diagnosed in hospital, <br/>which also carried a higher one-year mortality compared to those diagnosed in <br/>primary care. Healthcare encounters and costs were higher for all subgroups in <br/>the first year, decreasing in the second year to varying degrees. <br/>These papers provide an in-depth examination of a real-world HF patient <br/>population. Mortality was highest among patients diagnosed clinically, while <br/>those with a combination of recommended medications, generally lacking in <br/>the cohort, showed a decreased risk of readmission. The results underline the <br/>importance of correct diagnostic procedure and treatment to reduce morbidity, <br/>mortality and healthcare costs.}},
  author       = {{Davidge, Jason Troy}},
  isbn         = {{978-91-8021-605-0}},
  issn         = {{1652-8220}},
  language     = {{eng}},
  number       = {{2024:109}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Differentiation of clinical characteristics, mortality, healthcare utilization and costs among four subgroups in a population with heart failure}},
  url          = {{https://lup.lub.lu.se/search/files/194122320/Thesis_Jason_Davidge_LUCRIS.pdf}},
  year         = {{2024}},
}