In this large cohort of elderly patients without a history of HF, HF developed in three-quarters in the 5 years after their first MI; this proportion increased over time as peri-MI mortality rates declined. New-onset HF significantly increases the mortality risk among these patients.

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Among Medicare beneficiaries with heart failure, health care resource use at the end of life increased over time with higher rates of intensive care and higher costs. However, the use of hospice services also increased markedly, representing a shift in patterns of care at the end of life.

In this multinational study, there was variation across countries in 30-day readmission rates after STEMI, with readmission rates higher in the United States than in other countries. However, this difference was greatly attenuated after adjustment for length of stay.

ResearchRecherche C ongestive heart failure (CHF) afflicts up to 2% of North American adults and, despite many advances in diagnosis and therapy, still portends a poor prognosis, with 1-year mortality of 30%-50%. [1][2][3][4][5] Although the prognosis of patients with CHF is poor even with optimal management, suboptimal diagnosis, investigation and treatment of heart failure and comorbidities (e.g., coronary artery disease) in community-dwelling patients contributes to poor survival. [6][7][8][9] In previous studies hospital inpatients with CHF who were cared for by specialists received more evidence-based therapies and had better outcomes than those cared for by nonspecialists.8,10-13 However, none of these studies examined the care delivered after discharge from hospital. Although management in specialized multidisciplinary clinics is associated with better outcomes, 14 it is unclear whether similar benefits can be expected when patients are cared for by specialist physicians operating outside the setting of a multidisciplinary clinic. Two recent studies from the United States that reported better outcomes with specialist care 7,15 were flawed, in that neither study adjusted for frequency of outpatient visits or the possibility of time-dependent bias 16 (whereby some variables, including the number of visits, will change over time).To address this important public health issue, we sought to determine whether there is a relation between ambulatory care follow-up and outcomes in patients with new-onset CHF. MethodsWe linked 4 databases maintained by Alberta Health and Wellness, which record individual patient interactions with the health care system in Alberta: the Discharge Abstract Database, which records information (including dates, diagnoses and procedures) on all admissions to any of 128 acute care facilities; the Ambulatory There is uncertainty about whether physician specialty influences the outcomes of outpatients with congestive heart failure after adjustment for differences in case mix. Our objective was to determine the impact of physician specialty on outcomes in outpatients with new-onset congestive heart failure. Methods: The study was a population-based retrospective cohort study involving patients with new-onset congestive heart failure discharged from 128 acute care hospitals in Alberta between Apr. 1, 1998, and July 1, 2000. Outcomes were resource utilization (clinic visits, emergency department visits and hospital admissions) and survival at 30 days and 1 year. Results: A total of 3136 patients were discharged from hospital with a new diagnosis of congestive heart failure (median age 76 years, 50% men). Of these, 1062 (34%) received no follow-up visits for cardiovascular care, 738 (24%) were seen by a family physician (FP) alone, 29 (1%) by a specialist (cardiologist or general internist) alone and 1307 (42%) by both a specialist and an FP. Compared with patients who received no follow-up cardiovascular care, patients who received regular cardiovascular follow-up visits with a physician had f...

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.

Pre-existing diabetes confers higher risks than GDM. Diabetes is associated with adverse outcomes in singleton and twin pregnancies, and the increased risks are generally similar or less in twins, probably due to their higher "baseline" risks and closer clinical monitoring.

Aims: Previous epidemiologic studies of acute heart failure (AHF) have involved patients admitted to hospital and fail to account for that unknown proportion discharged directly from the emergency department (ED). We examined discharge rates, and whether outcomes, including mortality, differed based on admission status in AHF. Methods and results: This population-based cohort included all patients ≥ 65 years presenting to an Alberta ED with HF (ICD9-CM 428.x; 1998 to 2001). Patients were either not admitted (Not-ADM) or directly admitted to hospital (ADM) and followed for one-year.Of 10,415 AHF patients evaluated in the ED, 35% were Not-ADM whereas 65% were ADM. Thirty days after ED presentation the rates of death, re-ED or initial/re-hospitalisation were 3.3%, 44% and 19% for Not-ADM, and 10.9%, 33% and 21% for the ADM patients, respectively (all p b 0.0001). At one-year, the rates of death, re-ED or initial/re-hospitalisation were 20%, 82% and 58% for Not-ADM, and 34%, 72% and 60% for ADM, respectively (all p b 0.0001). Conclusions: One third of AHF patients were not immediately admitted after an ED visit but most present again to the ED, two-thirds were hospitalised and 20% died within the first year. Our findings provide new impetus to undertake risk assessment and treatment strategies in the ED for AHF.