Background
Methods
Results
General patient characteristics
Patient characteristics N [%] or mean [SD] | Overall population | East of England | London | North-East | North-West | South-east | South-west | South-central | West Midlands |
---|---|---|---|---|---|---|---|---|---|
Age (mean [SD]) | 76.2 [14.3] | 79.1 [11.9]^ | 78.6 [11.5]^ | 74.7 [15.0]** | 75.9 [12.5] | 79.8 [11.2]^ | 78.6 [11.4]^ | 79.6 [11.2]^ | 76.3 [13.9] |
Female sex | 3520 [37.2] | 404 [32.3]^ | 317 [26.9]^ | 484 [48.5]^ | 530 [29.6]^ | 395 [31.9]^ | 386 [28.1]^ | 380 [29.1]^ | 624 [52.4]^ |
Myocardial infarction | 1338 [14.1] | 177 [14.2] | 143 [12.1] | 246 [24.7]^ | 255 [14.2] | 151 [12.2] | 164 [11.9] | 150 [11.5] | 250 [21.2]^ |
Atrial fibrillation | 3174 [33.5] | 424 [33.9] | 327 [27.8]^ | 479 [48.2]^ | 509 [28.4]^ | 423 [34.2]^ | 382 [27.8]^ | 392 [29.9]^ | 626 [53.1]^ |
Myocarditis/Cardiomyopathy | 303 [3.2] | 30 [2.4] | 46 [3.9] | 61 [6.1]^ | 43 [2.4] | 53 [4.3] | 36 [2.6] | 36 [2.7] | 69 [5.8]^ |
Hypertension | 4494 [47.4] | 584 [46.7] | 517 [44.0]* | 742 [74.7]^ | 790 [44.1]* | 567 [45.7] | 511 [37.2]^ | 501 [38.3]^ | 860 [73.0]^ |
Diabetes | 1570 [16.6] | 195 [23.6] | 178 [15.1] | 250 [25.1]^ | 293 [16.3] | 191 [15.4] | 193 [14.0] | 177 [13.5]* | 274 [23.2]^ |
Valvular heart disease | 1392 [14.7] | 162 [12.9] | 150 [12.7] | 225 [22.6]^ | 276 [15.4] | 181 [14.6] | 168 [12.2] | 166 [12.7] | 270 [22.9]^ |
Peripheral vascular disease | 586 [6.2] | 63 [5.0] | 74 [6.3] | 106 [10.6]^ | 117 [6.5] | 66 [5.3] | 63 [4.6] | 73 [5.6] | 95 [8.0]* |
Dementia | 908 [9.8] | 112 [8.9] | 124 [10.5] | 160 [16.1]^ | 145 [8.1] | 94 [7.6]* | 96 [6.9] | 126 [9.6] | 185 [15.7]^ |
HF diagnosed as an inpatient | 4795 [50.6] | 548 [43.8]^ | 430 [36.5]^ | 743 [74.6]^ | 658 [36.8]^ | 493 [39.8]^ | 504 [36.6]^ | 532 [40.7]^ | 887 [74.6]^ |
Overall 5-year mortality | 3741 [39.5] | 402 [32.2]^ | 360 [30.6]^ | 485 [48.6]^ | 565 [31.5]^ | 400 [32.3]^ | 421 [30.6]^ | 454 [34.7]^ | 646 [54.3]^ |
Classification of groups in different regions
Regions | Total No. of patients | No. of groups | Intermediate groups (n) | Proportion of intermediate users | High-impact groups (n) | Types of high-impact users | Proportion of high-impact users |
---|---|---|---|---|---|---|---|
London | 1175 | 4 | 1 | 38.8% | 2 | Short-term | 6.6% |
Chronic | 6.2% | ||||||
East of England | 1249 | 5 | 2 | 29.5% | 2 | Short-term | 2.5% |
Chronic | 2.2% | ||||||
North-East | 996 | 5 | 2 | 21.9% | 2 | Short-term | 11.3% |
Chronic | 2.1% | ||||||
North-West | 1788 | 4 | 1 | 33.8% | 2 | Short-term | 4.9% |
Chronic | 10.2% | ||||||
South-Central | 1307 | 5 | 2 | 25.9% | 2 | Short-term | 7.2% |
Chronic | 1.9% | ||||||
South-East | 1238 | 5 | 2 | 40.1% | 2 | Short-term | 6.2% |
Chronic | 2.7% | ||||||
West-Midlands | 1189 | 5 | 2 | 23.4% | 2 | Short-term | 8.6% |
Chronic | 1.6% | ||||||
South-West | 1375 | 3 | 1 | 11.5% | 1 | Chronic | 12.1% |
Covariates associated with high-impact users
Short-term high-impact | OR [95% CI] | Chronic high-impact | OR [95% CI] |
---|---|---|---|
London | |||
Stroke^ | 4.39 [2.51–7.69] | Chronic renal disease+ | 11.82 [6.05–23.10] |
Anaemia^ | 4.26 [2.56–7.10] | Diabetes+ | 8.76 [5.05–15.18] |
Chronic renal disease* | 4.01 [2.23–7.24] | Valvular heart disease+ | 5.81 [3.39–9.97] |
Valvular heart disease* | 3.06 [1.84–5.10] | Stroke+ | 5.64 [3.16–10.07] |
Chronic respiratory disease* | 2.86 [1.75–4.66] | Chronic respiratory disease+ | 4.62 [2.64–8.08] |
Female sex* | 2.89 [1.68–4.95] | ||
Anaemia* | 2.75 [1.65–4.57] | ||
East of England | |||
Anaemia* | 8.33 [3.56–19.49] | ||
North-East | |||
Congenital heart disease* | 3.74 [2.27–6.17] | Hypertension+ | 14.88 [8.00–27.66] |
Chronic renal disease+ | 3.00 [2.64–3.42] | Cardiac arrhythmia+ | 6.17 [5.00–7.61] |
Dementia+ | 2.86 [2.46–3.32] | Mood disorder+ | 5.81 [4.62–7.32] |
Cardiac arrhythmia+ | 2.75 [2.41–3.13] | Chronic respiratory disease+ | 5.31 [4.18–6.75] |
Hypertension+ | 2.59 [2.16–3.10] | Chronic renal disease+ | 4.90 [3.97–6.05] |
Mood disorder+ | 2.51 [2.12–2.97] | Anaemia+ | 4.14 [3.39–5.05] |
Chronic respiratory disease+ | 2.32 [2.03–2.64] | Dementia+ | 3.86 [2.97–5.00] |
Anaemia+ | 2.23 [1.95–2.53] | Pulmonary embolism^ | 2.66 [1.86–3.82] |
Valvular heart disease+ | 2.12 [1.84–2.44] | Diabetes+ | 2.44 [1.99–2.97] |
Stroke+ | 1.65 [1.49–1.82] | Stroke+ | 2.29 [1.88–2.80] |
Atrial fibrillation* | 1.35 [1.22–1.49] | Atrial fibrillation+ | 2.18 [1.75–2.72] |
Older age+ | 0.74 [0.69–0.79] | Marital problems* | 2.18 [1.52–3.13] |
HF diagnosis as an inpatient^ | 0.61 [0.51–0.72] | Valvular heart disease^ | 2.12 [1.73–2.59] |
Peripheral vascular disease* | 1.82 [1.43–2.32] | ||
Ischaemic heart disease* | 1.58 [1.28–1.95] | ||
Exercise recommendation by GP* | 1.55 [1.25–1.93] | ||
History of flu vaccination+ | 1.52 [1.25–1.86] | ||
Older age+ | 0.41 [0.37–0.46] | ||
North-West | |||
Hypertension+ | 5.64 [3.42–9.30] | Older age* | 0.43 [0.31–0.59] |
Mood disorder+ | 3.29 [2.32–4.66] | Number of patients with increased out-of-hours GP visits (>90th percentile) ^ | 0.34 [0.23–0.50] |
Dementia^ | 3.13 [2.16–4.53] | GP visit for renal function monitoring* | 0.31 [0.19–0.51] |
Cardiac arrhythmia^ | 2.83 [2.10–3.82] | HF diagnosis as an inpatient+ | 0.19 [0.13–0.28] |
Chronic renal disease^ | 2.46 [1.82–3.32] | ||
Anaemia^ | 2.39 [1.77–3.22] | ||
Chronic respiratory disease* | 2.20 [1.63–2.97] | ||
History of flu vaccination* | 2.12 [1.54–2.92] | ||
Older age* | 0.48 [0.33–0.68] | ||
HF diagnosis as an inpatient* | 0.41 [0.27–0.61] | ||
South-Central | |||
Chronic respiratory disease^ | 5.93 [3.63–9.68] | Hypertension^ | 0.31 [0.17–0.55] |
Valvular heart disease+ | 5.75 [3.49–9.49] | Chronic renal disease* | 0.22 [0.14–0.37] |
Cardiac arrhythmia^ | 4.62 [2.64–8.08] | Older age* | 0.23 [0.12–0.41] |
Older age^ | 0.22 [0.13–0.39] | Dementia* | 0.19 [0.10–0.37] |
HF diagnosis as an inpatient+ | 0.06 [0.03–0.11] | ||
South-East | |||
Ischaemic heart disease+ | 17.64 [4.76–65.37] | Chronic renal disease* | 4.35 [3.00–6.30] |
Chronic renal disease^ | 8.76 [4.95–15.49] | Anaemia+ | 4.14 [2.89–5.93] |
Chronic respiratory disease^ | 5.53 [3.06–9.97] | Dementia^ | 3.16 [2.05–4.85] |
Cardiac arrhythmia* | 5.16 [3.00–8.85] | Cardiac arrhythmia* | 2.61 [1.80–3.78] |
Chronic respiratory disease+ | 2.23 [1.55–3.19] | ||
GP visit for HF medication review* | 0.38 [0.24–0.62] | ||
Older age* | 0.37 [0.23–0.58] | ||
West-Midlands | |||
Cardiac arrhythmia+ | 5.47 [3.49–8.58] | Chronic renal disease+ | 9.97 [5.21–19.11] |
Hypertension* | 4.06 [2.10–7.85] | Cardiac arrhythmia* | 5.70 [3.22–10.07] |
Chronic respiratory disease^ | 3.32 [2.18–5.05] | Stroke^ | 5.16 [2.94–9.03] |
Female sex* | 2.75 [1.73–4.35] | Chronic respiratory disease^ | 4.62 [2.61–8.17] |
Older age* | 0.39 [0.25–0.63] | Older age* | 0.26 [0.15–0.47] |
South-West | |||
History of flu vaccination* | 9.03 [3.00–27.11] | ||
Chronic respiratory disease* | 0.07 [0.02–0.25] | ||
Older age* | 0.03 [0.01–0.11] | ||
HF diagnosis as an inpatient+ | 0.01 [0.00–0.04] |
Intermediate group | OR [95% CI] | P value |
---|---|---|
London | ||
Hypertension | 2.80 [1.95–4.01] | 0.003 |
Chronic renal disease | 1.65 [1.27–2.14] | 0.05 |
Chronic respiratory disease | 1.63 [1.27–2.10] | 0.05 |
Number of patients with previous GP visit for HF medication review | 0.51 [0.37–0.71] | 0.04 |
Older age | 0.35 [0.26–0.46] | 0.002 |
East of England | ||
Diabetes | 0.32 [0.18–0.54] | 0.03 |
Chronic respiratory disease | 0.32 [0.19–0.54] | 0.03 |
Chronic renal disease | 0.21 [0.12–0.37] | 0.005 |
North-East | ||
Cardiac congenital conditions | 4.31 [2.51–7.39] | 0.007 |
Hypertension | 3.90 [3.32–4.57] | < 0.001 |
Ischaemic heart disease | 2.36 [1.79–3.13] | 0.002 |
Mood disorders | 2.32 [2.01–2.66] | < 0.001 |
Chronic renal diseases | 2.03 [1.84–2.25] | < 0.001 |
Valvular heart disease | 1.95 [1.73–2.20] | < 0.001 |
Cardiac arrhythmias | 1.93 [1.75–2.14] | < 0.001 |
Dementia | 1.80 [1.57–2.08] | < 0.001 |
Respiratory conditions | 1.54 [1.39–1.70] | < 0.001 |
Anaemia | 1.54 [1.38–1.72] | < 0.001 |
Stroke | 1.35 [1.20–1.52] | 0.012 |
Atrial fibrillation | 1.31 [1.19–1.45] | 0.0099 |
History of smoking | 0.87 [0.81–0.93] | 0.048 |
Number of patients with increased out-of-hours GP visits (>90th percentile) | 0.64 [0.55–0.75] | 0.0028 |
GP visit for renal monitoring | 0.62 [0.53–0.72] | 0.0016 |
Number of patients with previous GP visit for HF medication review | 0.62 [0.51–0.76] | 0.017 |
Older age | 0.57 [0.53–0.60] | < 0.001 |
> 3 hospital admissions in preceding year of diagnosis of HF vs. <=2) | 0.34 [0.25–0.45] | < 0.001 |
HF diagnosis as an inpatient | 0.32 [0.28–0.37] | < 0.001 |
North-West | ||
Hypertension | 11.36 [5.53–23.34] | < 0.001 |
Chronic renal disease | 5.81 [4.10–8.25] | < 0.001 |
Cardiac arrhythmias | 4.26 [3.10–5.87] | < 0.001 |
Atrial fibrillation | 2.72 [1.95–3.78] | 0.003 |
Mood disorder | 2.61 [1.79–3.82] | 0.012 |
Number of patients with GP visit for flu vaccination | 2.51 [1.80–3.49] | 0.005 |
Anaemia | 1.97 [1.46–2.66] | 0.033 |
Presentation of atypical signs and symptoms before the diagnosis of HF | 0.42 [0.28–0.64] | 0.04 |
HF diagnosis as an inpatient | 0.25 [0.16–0.38] | 0.001 |
Older age | 0.19 [0.13–0.27] | < 0.001 |
South-Central | ||
Chronic respiratory disease | 0.36 [0.23–0.56] | 0.024 |
Cardiac arrhythmia | 0.25 [0.15–0.43] | 0.011 |
Dementia | 0.24 [0.14–0.44] | 0.016 |
Hypertension | 0.22 [0.13–0.37] | 0.004 |
Chronic renal disease | 0.17 [0.11–0.29] | < 0.001 |
South-East | ||
Hypertension | 5.37 [2.97–9.68] | 0.004 |
Older age | 0.23 [0.16–0.35] | < 0.001 |
HF diagnosis as an inpatient | 0.15 [0.11–0.21] | < 0.001 |
West-Midlands | ||
Hypertension | 3.16 [2.25–4.44] | < 0.001 |
Chronic respiratory disease | 2.01 [1.55–2.61] | 0.007 |
Atrial fibrillation | 1.86 [1.42–2.44] | 0.023 |
Valvular heart disease | 1.82 [1.36–2.44] | 0.042 |
HF diagnosis as an inpatient | 0.42 [0.32–0.57] | 0.003 |
Older age | 0.36 [0.27–0.48] | < 0.001 |
South-West | ||
Hypertension | 4.81 [3.39–6.82] | < 0.001 |
Atrial fibrillation | 1.80 [1.38–2.36] | 0.03 |
HF diagnosis as an inpatient | 0.39 [0.27–0.56] | 0.01 |
Number of patients with previous GP visit for HF medication review | 0.28 [0.19–0.41] | < 0.001 |
Sequence analysis of causes of emergency readmissions
Sequences of readmissions | Low-impact [%] | Intermediate [%] | Short-term high-impact [%] | Chronic high-impact [%] |
---|---|---|---|---|
London | ||||
UTI-RTI | 0.4 | 1.9 | 4.4 | 17.5 |
Chest s/s-Abdo s/s | 0.01 | 4.7 | 4.4 | 7.5 |
RTI-HF | 0.4 | 1.8 | 8.8 | 10.0 |
RTI-UTI | 0.4 | 3.3 | 8.8 | 10.0 |
RTI-Chest s/s | 0.01 | 1.4 | 4.4 | 10.0 |
East of England | ||||
IHD-chest s/s | 6.0 | 0.3 | 1.9 | 17.3 |
RTI-Chest s/s | 3.0 | 0.3 | 1.9 | 17.4 |
Chest s/s-IHD | 0.9 | 0.01 | 0.9 | 13.0 |
Chest s/s-RTI | 3.0 | 0.3 | 8.8 | 17.4 |
MI-IHD | 6.0 | 0.3 | 6.8 | 4.3 |
North-East | ||||
HF-Chest s/s | 10.4 | 3.1 | 0.9 | 15.4 |
UTI-RTI | 6.8 | 0.8 | 0.6 | 11.5 |
Chest s/s-HF | 6.5 | 5.5 | 0.6 | 11.5 |
RTI-Cancer | 3.4 | 4.7 | 0.01 | 3.8 |
North-West | ||||
Chest s/s-RTI | 1.2 | 9.0 | 9.6 | 1.1 |
RTI-INJ | 0.3 | 6.5 | 2.4 | 0.4 |
RTI-cancer | 0.6 | 1.6 | 4.8 | 0.01 |
RT-Chest s/s | 0.6 | 4.1 | 5.6 | 0.6 |
RTI-IHD | 0.3 | 2.4 | 0.01 | 4.0 |
South-Central | ||||
INJ-RTI | 2.1 | 0.01 | 0.01 | 12.5 |
Chest s/s-RTI | 0.01 | 0.01 | 1.6 | 6.3 |
INJ-INJ-RTI | 2.1 | 0.01 | 0.01 | 6.3 |
RTI-INJ | 0.7 | 0.01 | 0.8 | 6.3 |
HF-Chest s/s | 1.4 | 0.01 | 2.3 | 6.3 |
South-East | ||||
UTI-RTI | 0.3 | 0.7 | 14.3 | 5.6 |
RTI-INJ | 0.0 | 3.4 | 5.7 | 5.6 |
INJ-RTI | 1.2 | 2.7 | 14.3 | 3.4 |
INJ-SALT | 0.3 | 1.3 | 5.7 | 5.6 |
SALT-INJ | 0.6 | 0.9 | 2.8 | 6.7 |