DIFFERENT HORIZONS, UNEVEN GAINS: TEMPORAL TRENDS IN ADMISSION-ANCHORED OUTCOMES FROM FIRST HFREF HOSPITALIZATION IN SINGAPORE
Author(s)
Sibo Liu, MS, PhD Candidate1, Nicholas Graves, PhD1, Audry Lee, MRCP2, Chun Fan Lee, PhD3, Sameera Senanayake, MD, PhD1, Weien Chow, MBBS4, Kelvin Bryan Tan, PhD5, Khung Keong Yeo, MBBS2, Derek Hausenloy, PhD6, Sanjeewa Kularatna, MD, PhD1.
1Health Services Research & Population Health (HSRPH), Duke-NUS Medical School, Singapore, Singapore, 2Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore, 3Centre for Biomedical Data Science (CBDS), Duke-NUS Medical School, Singapore, Singapore, 4Department of Cardiology, Changi General Hospital, Singapore, Singapore, 5Ministry of Health, Singapore, Singapore, 6Cardiovascular & Metabolic Disorders (CVMD) Program, Duke-NUS Medical School, Singapore, Singapore.
1Health Services Research & Population Health (HSRPH), Duke-NUS Medical School, Singapore, Singapore, 2Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore, 3Centre for Biomedical Data Science (CBDS), Duke-NUS Medical School, Singapore, Singapore, 4Department of Cardiology, Changi General Hospital, Singapore, Singapore, 5Ministry of Health, Singapore, Singapore, 6Cardiovascular & Metabolic Disorders (CVMD) Program, Duke-NUS Medical School, Singapore, Singapore.
OBJECTIVES: Heart failure hospitalization marks a pivotal event whose consequences extend beyond the index episode. Although in-hospital mortality and length of stay (LOS) characterize the acute phase, admission-anchored days alive and out of hospital (DAOH) may provide a patient-centered summary of cumulative health over broader horizons. We examined temporal trends in admission-anchored outcomes from first hospitalization for heart failure with reduced ejection fraction (HFrEF) in Singapore, and whether trends differed across population subgroups.
METHODS: Using the Singapore Cardiovascular Longitudinal Outcomes Database, we conducted a population-based cohort study of patients with a first HFrEF hospitalization between 2011-2019. We estimated risk-adjusted temporal trends in in-hospital mortality, index LOS, and admission-anchored 30-day and 1-year DAOH, and assessed heterogeneity in trend slopes by age, sex, and ethnicity.
RESULTS: The cohort included 10,344 patients (mean age, 68.5±13.3 years; 31.7% women). Risk-adjusted 30-day DAOH showed little overall temporal change (0.04 days/year, 95% confidence interval [CI], -0.01 to 0.09; P-trend = 0.081), but temporal slopes differed by sex (P-interaction=0.005), with a positive slope in men whereas a negative slope in women (0.09 versus -0.05 days/year). In contrast, 1-year DAOH improved from 275.1 to 290.4 days (1.94 days/year [95% CI, 1.41 to 2.47]; P-trend<0.001), with heterogeneity in temporal slopes by age and ethnicity (P-interaction=0.022 and 0.013, respectively). Annual gains were greater in Malay than Chinese patients after multiplicity adjustment (3.40 versus 1.55 days/year; P-adjusted =0.006). Acute-phase outcomes showed little overall temporal change or subgroup heterogeneity.
CONCLUSIONS: There was improvement in admission-anchored 1-year DAOH but not 30-day DAOH or acute-phase outcomes, indicating temporal gains became evident over longer horizons. Dissimilar slopes highlight potentially uneven accrual of benefits across subgroups. Future outcome surveillance may consider pairing conventional metrics with DAOH into a multi-horizon, equity-focused framework.
METHODS: Using the Singapore Cardiovascular Longitudinal Outcomes Database, we conducted a population-based cohort study of patients with a first HFrEF hospitalization between 2011-2019. We estimated risk-adjusted temporal trends in in-hospital mortality, index LOS, and admission-anchored 30-day and 1-year DAOH, and assessed heterogeneity in trend slopes by age, sex, and ethnicity.
RESULTS: The cohort included 10,344 patients (mean age, 68.5±13.3 years; 31.7% women). Risk-adjusted 30-day DAOH showed little overall temporal change (0.04 days/year, 95% confidence interval [CI], -0.01 to 0.09; P-trend = 0.081), but temporal slopes differed by sex (P-interaction=0.005), with a positive slope in men whereas a negative slope in women (0.09 versus -0.05 days/year). In contrast, 1-year DAOH improved from 275.1 to 290.4 days (1.94 days/year [95% CI, 1.41 to 2.47]; P-trend<0.001), with heterogeneity in temporal slopes by age and ethnicity (P-interaction=0.022 and 0.013, respectively). Annual gains were greater in Malay than Chinese patients after multiplicity adjustment (3.40 versus 1.55 days/year; P-adjusted =0.006). Acute-phase outcomes showed little overall temporal change or subgroup heterogeneity.
CONCLUSIONS: There was improvement in admission-anchored 1-year DAOH but not 30-day DAOH or acute-phase outcomes, indicating temporal gains became evident over longer horizons. Dissimilar slopes highlight potentially uneven accrual of benefits across subgroups. Future outcome surveillance may consider pairing conventional metrics with DAOH into a multi-horizon, equity-focused framework.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD3
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Health Service Delivery & Process of Care
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)