Longitudinal Trajectories of Hospitalizations in U.S. Older Adults with Heart Failure

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Publication Details

Journal
The Journals of Gerontology Series A
Published
2026-09-16
DOI
https://doi.org/10.1093/gerona/glag233
Primary Topic
Heart Failure Treatment and Management
Type
article
Field-Weighted Citation Impact
0.00
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article

Longitudinal Trajectories of Hospitalizations in U.S. Older Adults with Heart Failure

Radha Dhingra, Scott M. Lynch, Eric D. Peterson, Bradley G. Hammill et al.
The Journals of Gerontology Series A
Heart Failure Treatment and Management
article

Longitudinal Trajectories of Hospitalizations in U.S. Older Adults with Heart Failure

Radha Dhingra, Scott M. Lynch, Eric D. Peterson, Bradley G. Hammill, Jessica West, Michael D. Green, Lesley H Curtis, Hanzhang Xu, Matthew E Dupre, Zhen Li
article en

Abstract

BACKGROUND: Little is known about long-term risks of hospitalizations among heart failure (HF) older adults at a national level. We identified long-term patterns of hospitalizations following the diagnosis of HF and assessed whether high-risk patients can be identified prior to discharge. METHODS: This is a retrospective cohort study from 2010 to 2020. Fee-for-service Medicare beneficiaries with newly-diagnosed HF during an inpatient stay and followed for up to 5 years. Group-based trajectory models (GBTM) identified 4 trajectories of all-cause hospitalizations during follow-up. LASSO regression was used to identify patients' baseline characteristics to predict their hospitalization trajectories. Model discrimination was assessed using C-statistics and calibration was evaluated using expected-to-observed ratios. RESULTS: Of the 84,597 Medicare beneficiaries with newly-diagnosed HF (mean age: 77.4 [± 7.1] years and 58.3% male), we identified 4 distinct trajectories of hospitalizations: Group 1 (n = 19,340; 22.9%) had consistently "low risks" of hospitalization, Group 2 (n = 53,922; 57.9%) had elevated risks shortly after discharge ("high-to-low risk"), Group 3 (n = 5,035; 9.8%) had elevated risks at later stages of illness ("low-to-high risk"), and Group 4 (n = 6,300; 9.4%) had consistently "high risks" of hospitalization. Models were well-calibrated predicting hospitalization trajectories (compared to low-risk patients [Group 1]), and C-statistics were 0.65 (Group 2), 0.68 (Group 3), and 0.79 (Group 4). Discrimination was consistently better among patients ≤70 years and calibration remained excellent across all subgroups with expected-to-observed ratios near 1.0. CONCLUSIONS: High-risk HF patients could be identified at the time-of-diagnosis using routinely available clinical characteristics, enabling targeted interventions during critical periods to improve long-term outcomes.

The Journals of Gerontology Series A
Johns Hopkins University (US), Duke University (US), Clinical Research Institute (US), Duke-NUS Medical School (SG), Duke University Health System (US), The University of Texas Southwestern Medical Center (US)
Peace, Justice and strong institutions
Openalex Percentile: Top 11%
Heart Failure Treatment and Management
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