Research Article| Volume 29, ISSUE 3, P278-289, March 2023

Download started.


Rethinking Rehospitalization in Heart Failure Care Transitions: Heterogeneity in Use Typologies

  • Sijia Wei
    Reprint requests: Sijia Wei, PhD, RN, Center for Education in Health Sciences, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611.
    School of Nursing, Duke University, Durham, North Carolina

    Center for Education in Health Sciences, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
    Search for articles by this author
  • Eleanor S. Mcconnell
    School of Nursing, Duke University, Durham, North Carolina

    Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina

    Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
    Search for articles by this author
  • Wei Pan
    School of Nursing, Duke University, Durham, North Carolina

    Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina
    Search for articles by this author
  • Kirsten N. Corazzini
    School of Nursing, Duke University, Durham, North Carolina

    School of Nursing, University of Maryland, Baltimore, Maryland
    Search for articles by this author
  • Bradi B. Granger
    School of Nursing, Duke University, Durham, North Carolina

    Heart Center Nursing Research Program, Duke University Health System and School of Nursing, Durham, North Carolina
    Search for articles by this author


      • High heterogeneity exists in health care use by patients with heart failure for various services.
      • A small subgroup of high users utilized the majority of acute and ambulatory care resources.
      • High outpatient use was associated with high acute-care use.
      • Faster change in the severity of illness increased the likelihood of high use.
      • Group-based trajectory modeling complements 30-day readmission rate as a means of improving care for those with heart failure.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Cardiac Failure
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Virani SS
        • Alonso A
        • Benjamin EJ
        • Bittencourt MS
        • Callaway CW
        • Carson AP
        • et al.
        American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2020 update: a report from the American Heart Association.
        Circulation. 2020; 141: e139-e596
        • Urbich M
        • Globe G
        • Pantiri K
        • Heisen M
        • Bennison C
        • Wirtz HS
        • Di Tanna GL.
        A systematic review of medical costs associated with heart failure in the USA (2014–2020).
        Pharmacoeconomics. 2020; 38: 1219-1236
        • Chamberlain AM
        • Dunlay SM
        • Gerber Y
        • Manemann SM
        • Jiang R
        • Weston SA
        • Roger VL.
        Burden and timing of hospitalizations in heart failure: A community study.
        Mayo Clin Proc. 2017; 92: 184-192
        • Blecker S
        • Herrin J
        • Li L
        • Yu H
        • Grady JN
        • Horwitz LI.
        Trends in hospital readmission of Medicare-covered patients with heart failure.
        J Am Coll Cardiol. 2019; 73: 1004-1012
        • Wammes JJG
        • Auener S
        • van der Wees PJ
        • Tanke MAC
        • Bellersen L
        • Westert GP
        • et al.
        Characteristics and health care utilization among patients with chronic heart failure: a longitudinal claim database analysis.
        ESC Heart Fail. 2019; 6: 1243-1251
        • Safstrom E
        • Jaarsma T
        • Stromberg A.
        Continuity and utilization of health and community care in elderly patients with heart failure before and after hospitalization.
        BMC Geriatr. 2018; 18: 177
        • Bayliss EA
        • Ellis JL
        • Shoup JA
        • Zeng C
        • McQuillan DB
        • Steiner JF.
        Effect of continuity of care on hospital utilization for seniors with multiple medical conditions in an integrated health care system.
        Ann Fam Med. 2015; 13: 123-129
        • Jones BL
        • Nagin DS.
        Advances in group-based trajectory modeling and an SAS procedure for estimating them.
        Sociol Methods Res. 2007; 35: 542-571
        • Benchimol EI
        • Smeeth L
        • Guttmann A
        • Harron K
        • Moher D
        • Petersen I
        • et al.
        The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement.
        PLoS Med. 2015; 12e1001885
        • Horvath MM
        • Winfield S
        • Evans S
        • Slopek S
        • Shang H
        • Ferranti J.
        The DEDUCE Guided Query tool: providing simplified access to clinical data for research and quality improvement.
        J Biomed Inform. 2011; 44: 266-276
      1. R: a language and environment for statistical computing [computer program].
        R Foundation for Statistical Computing, Vienna, Austria2013 (Version 3.6.3.)
        • Chamberlain RS
        • Sond J
        • Mahendraraj K
        • Lau CS
        • Siracuse BL.
        Determining 30-day readmission risk for heart failure patients: the Readmission After Heart Failure scale.
        Int J Gen Med. 2018; 11: 127-141
        • Li L
        • Baek J
        • Jesdale BM
        • Hume AL
        • Gambassi G
        • Goldberg RJ
        • Lapane KL.
        Predicting 30-day mortality and 30-day rehospitalization risks in Medicare patients with heart failure discharged to skilled nursing facilities: development and validation of models using administrative data.
        J Nurs Home Res Sci. 2019; 5: 60-67
        • Su A
        • Al'Aref SJ
        • Beecy AN
        • Min JK
        • Karas MG.
        Clinical and socioeconomic predictors of heart failure readmissions: A review of contemporary literature.
        Mayo Clin Proc. 2019; 94: 1304-1320
        • Patel SA
        • Krasnow M
        • Long K
        • Shirey T
        • Dickert N
        • Morris AA.
        Excess 30-day heart failure readmissions and mortality in Black patients increases with neighborhood deprivation.
        Circ Heart Fail. 2020; 13e007947
        • Knighton AJ
        • Savitz L
        • Belnap T
        • Stephenson B
        • VanDerslice J.
        Introduction of an area deprivation index measuring patient socioeconomic status in an integrated health system: implications for population health.
        EGEMS (Washington, DC). 2016; 4: 1238
        • Quan H
        • Li B
        • Couris CM
        • Fushimi K
        • Graham P
        • Hider P
        • et al.
        Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries.
        Am J Epidemiol. 2011; 173: 676-682
      2. Averill RF, Goldfield N, Hughes JS, Bonazelli J, McCullough EC, Steinbeck BA, et al. CT: 3M Health Information Systems. All patient refined diagnosis related groups (APR-DRGs) version 20.0: Methodology overview. 2003;91:7-81.

        • Vaishnav J
        • Sharma K.
        A stepwise guide to the diagnosis and treatment of heart failure with preserved ejection fraction.
        J Card Fail. 2022; 28: 1016-1030
      3. IBM SPSS statistics for Windows [computer program]. Version 27.0. IBM, Armonk, NY, 2020.

      4. Little RJA. A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association. 1988;83(404):1198–1202

        • Rao A
        • Kim D
        • Darzi A
        • Majeed A
        • Aylin P
        • Bottle A.
        Long-term trends of use of health service among heart failure patients.
        Eur Heart J Qual Care Clin Outcomes. 2018; 4: 220-231
        • Ng SH-X
        • Rahman N
        • Ang IYH
        • Sridharan S
        • Ramachandran S
        • Wang DD
        • et al.
        Characterization of high healthcare utilizer groups using administrative data from an electronic medical record database.
        BMC Health Serv Res. 2019; 452: 1-14
        • Cainzos-Achirica M
        • Capdevila C
        • Vela E
        • Cleries M
        • Bilal U
        • Garcia-Altes A
        • et al.
        Individual income, mortality and healthcare resource use in patients with chronic heart failure living in a universal healthcare system: a population-based study in Catalonia, Spain.
        Int J Cardiol. 2019; 277: 250-257
        • Maciejewski ML
        • Powers BJ
        • Sanders LL
        • Farley JF
        • Hansen RA
        • Sleath B
        • Voils CI.
        The intersection of patient complexity, prescriber continuity and acute care utilization.
        J Gen Intern Med. 2014; 29: 594-601
        • McWilliams JM.
        Cost containment and the tale of care coordination.
        N Engl J Med. 2016; 375: 2218-2220
        • Fang JC
        • Ewald GA
        • Allen LA
        • Butler J
        • Westlake Canary CA
        • Colvin-Adams M
        • et al.
        Advanced (stage D) heart failure: a statement from the Heart Failure Society of America Guidelines Committee.
        J Card Fail. 2015; 21: 519-534
        • Wong EG
        • Parker AM
        • Leung DG
        • Brigham EP
        • Arbaje AI.
        Association of severity of illness and intensive care unit readmission: a systematic review.
        Heart Lung. 2016; 45 (3–9.e2)
        • Dupre ME
        • Gu D
        • Xu H
        • Willis J
        • Curtis LH
        • Peterson ED.
        Racial and ethnic differences in trajectories of hospitalization in US men and women with heart failure.
        J Am Heart Assoc. 2017; 11: e006290
        • White-Williams C
        • Rossi LP
        • Bittner VA
        • Driscoll A
        • Durant RW
        • Granger BB
        • et al.
        Addressing social determinants of health in the care of patients with heart failure: a scientific statement from the American Heart Association.
        Circulation. 2020; 141: e841-e863