ArticleCirculation. Population health and outcomes2026
Shifting From Event Rates to Time at Home After Hospitalization for Heart Failure With Reduced Ejection Fraction: Trends and Equity in Days Alive and Out of Hospital in Singapore.
Article in Circulation. Population health and outcomes, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundConventional postdischarge monitoring for heart failure (HF) with reduced ejection fraction focuses on readmission and mortality, but these end points may not summarize cumulative patient-centered health. We examined whether secular trends in conventional end points translated into improved days alive and out of hospital (DAOH), and whether trends differed by age, sex, and ethnicity.
methodsUsing the Singapore Cardiovascular Longitudinal Outcomes Database, we conducted a population-based cohort study of patients discharged alive after first HF with reduced ejection fraction hospitalization during 2011 to 2019. We estimated risk-adjusted annual trends in 30-day and 1-year DAOH, all-cause and HF-specific readmission, and all-cause and cardiovascular mortality, and tested trend heterogeneity by age, sex, and ethnicity with multiplicity adjustment.
resultsAmong 10 147 patients (median age, 68.9 years; 31.5% women; 65.4% Chinese; 20.0% Malay), risk-adjusted 30-day DAOH did not change materially (annual change, 0.01 [95% CI, -0.03 to 0.05] d/y;
conclusionsImprovement was seen in 1-year but not 30-day DAOH after first HF with reduced ejection fraction hospitalization, alongside reductions in 1-year HF-specific readmission, all-cause mortality, and cardiovascular mortality. Dissimilar slopes highlight potentially inequitable benefits. DAOH may provide a patient-centered complement to conventional end points for monitoring burden and equity.
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