Objective To determine the lifetime burden and risk factors for hospitalization after heart failure (HF) diagnosis in the community. Background Hospitalizations in patients with HF represent a major public health problem, however the cumulative burden of hospitalizations after HF diagnosis is unknown, and no consistent risk factors for hospitalization have been identified. Methods We validated a random sample of all incident HF cases in Olmsted County, Minnesota from 1987–2006 and evaluated all hospitalizations after HF diagnosis through 2007. International Classification of Diseases, 9th Revision codes were used to determine the primary reason for hospitalization. To account for repeated events, Andersen-Gill models were used to determine the predictors of hospitalization after HF diagnosis. Patients were censored at death or last follow-up. Results Among 1077 HF patients (mean age 76.8 years, 582 [54.0%] female), 4359 hospitalizations occurred over a mean follow-up of 4.7 years. Hospitalizations were common after HF diagnosis, with 895 (83.1%) patients hospitalized at least once, and 721 (66.9%), 577 (53.6%) and 459 (42.6%) hospitalized ≥2, ≥3, and ≥4 times, respectively. The reason for hospitalization was HF in 713 (16.5%) hospitalizations, other cardiovascular in 936 (21.6%), while over half (n=2679, 61.9%) were non-cardiovascular. Male sex, diabetes mellitus, chronic obstructive pulmonary disease, anemia, and creatinine clearance <30 mL/min were independent predictors of hospitalization (p<0.05 for each). Conclusions Multiple hospitalizations are common after HF diagnosis, though less than half are due to cardiovascular causes. Comorbid conditions are strongly associated with hospitalizations, information that could be used to define effective interventions to prevent hospitalizations in HF patients.

Background-Heart failure (HF) care constitutes an increasing economic burden on the health care system, and has become a key focus in the health care debate. However, there are limited data on the lifetime health care costs for individuals with HF after initial diagnosis. Methods and Results-Olmsted County residents with incident HF from 1987 to 2006 were identified. Direct medical costs incurred from the time of HF diagnosis until death or last follow-up were obtained using population-based administrative data through 2007. Costs were inflated to 2008 US dollars using the general Consumer Price Index. Inpatient, outpatient, and total costs were estimated using a 2-part model with adjustment for right censoring of data. Predictors of total costs were examined using a similar model.

The comanagement medical Hospitalist-Orthopedic Team model reduced minor postoperative complication rates with no statistically significant difference in length of stay or cost. The nurses and surgeons strongly preferred the comanagement hospitalist model. Additional research on the clinical and economic impact of the hospitalist model in other surgical populations is warranted.

In elderly patients with hip fracture, a hospitalist model decreased time to surgery, time from surgery to dismissal, and length of stay without adversely affecting inpatient deaths or 30-day readmission rates.

Laparoscopic ileocolic resection for CD is feasible. There are significant postoperative benefits in terms of resolution of ileus, narcotic use, and hospital stay. This approach translates into cost savings of >$3300 for laparoscopic patients.

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SUMMARY BackgroundDespite increasing prevalence, the economic implications of coeliac disease are just emerging.

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