Abstract 4347517: Potential Patient Eligibility for Hospital at Home for Management of Worsening Heart Failure in the United States
Bibliographic record
Abstract
Introduction/Background: Hospital at Home (HaH) is an emerging, patient-centered clinical model by which patients receive inpatient-level care at home. HaH may be particularly well-suited to the care of patients with worsening heart failure (WHF). Research Questions: Our study sought to examine, if implemented widely, what proportion of US patients hospitalized with WHF would be eligible for HaH care. We also sought to determine the clinical and demographic differences between HaH eligible and ineligible populations. Methods/Approach: Among US patients hospitalized for WHF in the Get With The Guidelines – Heart Failure (GWTG-HF) registry from 2021-2024, we applied generally accepted and/or required (by Medicare) social and clinical criteria for HaH to estimate the proportion of patients potentially eligible for HaH. We then further compared the demographics, vital signs and laboratory findings, comorbidities, mortality, and length of stay for the HaH eligible and ineligible groups. Results/Data: Among 81,610 patients hospitalized across 204 sites, 49,544 (60.7%) were projected as eligible for HaH (Table 1) . Eligibility rates were >50% across demographic and geographic subgroups but tended to be higher among patients age >75 years, women, and Hispanic patients, as well as among patients hospitalized in urban areas and the Northeast US (Figure) . Eligible patients were less likely to have a history of chronic kidney disease and had a lower median GWTG-HF risk score (Table 2) . Patients eligible for HaH had lower in-hospital mortality and shorter length of stay (Table 2) . Conclusions: In this nationwide cohort of US patients hospitalized for WHF, approximately 6 out of 10 patients were projected as potentially eligible for HaH, with modest variability across demographic and geographic subgroups. Patients eligible for HaH demonstrated a lower risk clinical profile. HaH could conceivably be a viable treatment strategy for the majority of US patients with WHF, and national efforts to continue or expand HaH have the potential to substantially impact WHF care delivery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".