Factors associated with increased hospital utilization in patients with heart failure and preserved ejection fraction.

STUDY OBJECTIVE

To determine whether controlling systolic blood pressure (SBP), pulse pressure, and heart rate in the outpatient setting is associated with decreased hospital utilization in patients with heart failure and preserved ejection fraction (PEF).

DESIGN

Retrospective medical record review.

SETTING

University-affiliated medical center and outpatient clinics.

PATIENTS

One hundred forty adults admitted between January 1, 2003, and October 31, 2005, for an exacerbation of heart failure with PEF and followed for 2 years after their index admission.

MEASUREMENTS AND MAIN RESULTS

Outpatient SBP, pulse pressure, and heart rate, and the percentage of clinic visits for which patients had each vital sign at a certain level were used for correlations and comparisons. These vital signs and percentages of clinic visits were varied until maximum significant differences were observed in total hospital utilization for each parameter. These values were then analyzed for differences based on age, race-ethnicity, and sex. When comparing patients whose vital signs were in control for at least 80% of clinic visits versus those whose were in control for less than 80% of clinic visits, significantly lower hospital utilization was associated with clinic SBP less than 140 mm Hg (median hospital utilization 3 vs 5 visits, p=0.0252), pulse pressure less than 65 mm Hg (3 vs 5 visits, p=0.0113), and heart rate of 55-70 beats/minute (2 vs 4 visits, p=0.0311). Among the 140 patients, 78 (56%) were Caucasian, 48 (34%) were Hispanic, and 14 (10%) were African-American. The African-American patients were significantly younger (p=0.0218) and had significantly poorer SBP control (< 140 mm Hg for >/= 80% of clinic visits: 14.3% vs 43.8%, p=0.0446) and higher hospital utilization (> 4 visits: 78.6% vs 43.8%, p=0.0218) than the Hispanic patients, despite similar percentages of missed clinic appointments (25% for each group).

CONCLUSION

Controlling SBP at less than 140 mm Hg, pulse pressure at less than 65 mm Hg, and heart rate at 55-70 beats/minute for at least 80% of clinic visits were factors associated with decreased hospital utilization. African-American patients with heart failure and PEF were younger, had more poorly controlled SBP, and had higher hospital utilization despite similar percentage of missed clinic visits as their Hispanic counterparts.