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Differentiating “Acute on Chronic” and Chronic Heart and Respiratory Failure

By Ori Nevo, MPH , Marie Steele-Adjognon, PhD and Lane Koenig, PhD
November 14, 2022

Heart failure and respiratory failure are among the most common causes of hospitalization and death in the United States.  In fact, primary or secondary diagnoses of respiratory failure and heart failure accounted for roughly 16% and 25%, respectively, of traditional Medicare hospitalizations in 2018.  For most of these hospitalizations, respiratory failure appears as a secondary condition (90.1%) as does heart failure (97.9%).  While heart failure and respiratory failure are chronic conditions, patients may be hospitalized with acute exacerbations of these conditions, described as “acute on chronic” conditions. While risk adjustment models to assess provider performance on quality used by the Centers for Medicare & Medicaid Services (CMS) control for respiratory and heart failure, these models do not differentiate acute on chronic from chronic (non-acute).

To better understand similarities and differences in patients with and without acute on chronic conditions, we compared length of stays in a short-term acute care hospital (STACH) and post-STACH use patterns between two groups of patient with heart failure or respiratory failure: (1) Medicare beneficiaries hospitalized with a principal or secondary diagnosis of acute on chronic heart or respiratory failure; (2) Medicare beneficiaries hospitalized with a principal or secondary diagnosis of chronic (non-acute) respiratory or heart […]

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