Imperial College London
Alternate

Alex Bottle

Faculty of Medicine, School of Public Health

Professor of Medical Statistics
 
 
 
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Contact

 

+44 (0)20 7594 0913robert.bottle Website

 
 
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Location

 

3 Dorset Rise, London EC4Y 8ENCharing Cross HospitalCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Rao:2018:ehjqcco/qcy013,
author = {Rao, A and Kim, D and Darzi, A and Majeed, A and Aylin, P and Bottle, A},
doi = {ehjqcco/qcy013},
journal = {European Heart Journal - Quality of Care and Clinical Outcomes},
pages = {220--231},
title = {Long-term trends of use of health service among heart failure patients},
url = {http://dx.doi.org/10.1093/ehjqcco/qcy013},
volume = {4},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Aims: We aimed to identify subgroups in the patient population with different trajectories of long-term readmission rates. The study also aimed to assess common causes and their sequences of readmissions for each subgroup. Methods: Patients with a primary diagnosis of heart failure (HF) in the period 2008-2009 were identified using nationally representative primary care data linked to national hospital data, which contain information on 10.5 million patients. HF patients were followed up for 5 years. Group-based trajectory models and sequence analysis were applied. Results: The model categorised the HF population (n = 9466) into 5 subgroups: low-impact (66.9%); two intermediate ones (27.4%); chronic high-impact (2.3%) with steady high annual readmission rates; and short-term high-impact (3.4%) with rapid decline in readmission rates. The groups were defined by their trends of yearly number of readmissions. The all-cause 5-year mortality was highest in the short-term high-impact group (n = 185, 72.8%), followed by group 2 (intermediate users) (n = 744, 58.8%), low-impact (n = 4244, 56.9%), chronic high-impact (n = 88, 37.6%) and group 1 (intermediate users) (n = 401, 30.3%) (p < 0.01). Compared with low-impact users, high-impact users were associated with higher mortality, bereavement episodes, and more out-of-hours GP visits. The chronic high-impact users had distinct sequences of causes of emergency admissions most often consisting of chest infection, ischaemic heart disease, and cardio-pulmonary signs and/or symptoms. Conclusion: Chronic high-impact users constitute a small proportion of total patients, but they have increasingly high use of healthcare services. Short-term high-impact users represent largely end of life patients. They require prompt involvement of the palliative care team to reduce unnecessary readmissions to hospital.
AU  - Rao,A
AU  - Kim,D
AU  - Darzi,A
AU  - Majeed,A
AU  - Aylin,P
AU  - Bottle,A
DO  - ehjqcco/qcy013
EP  - 231
PY  - 2018///
SN  - 2058-5225
SP  - 220
TI  - Long-term trends of use of health service among heart failure patients
T2  - European Heart Journal - Quality of Care and Clinical Outcomes
UR  - http://dx.doi.org/10.1093/ehjqcco/qcy013
UR  - https://www.ncbi.nlm.nih.gov/pubmed/29718210
UR  - http://hdl.handle.net/10044/1/58892
VL  - 4
ER  -
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