Heart Failure Patients Achieve Clinically Relevant Thresholds in Patient-Reported Outcome Measures After Total Hip Arthroplasty Despite Higher Health-Care Utilization.

Abstract

Given improved treatments and prolonged life expectancy, the number of patients who have heart failure (HF) and undergo total hip arthroplasty (THA) will likely increase; however, few studies evaluate patient-reported outcome measures (PROMs) after THA among these patients. This study aimed to 1) compare achievement of clinically relevant PROM thresholds after THA between HF patients and patients who do not have HF, and 2) report health-care utilization after THA between these patient cohorts and HF patients who have various ejection fraction percentages (EF%). A prospective cohort of 10,590 primary THA patients at a tertiary center was included. A total of 372 patients had HF and were categorized by EF%: preserved (≥ 50%), mildly reduced (41 to 49%), and reduced (≤ 40%). The PROMs included the Hip Injury and Osteoarthritis Outcome Score for Pain (HOOS-Pain), Hip Disability and Osteoarthritis Outcome Score-Physical Function (HOOS-PS), and Hip Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS-JR) with minimal clinically important differences (MCIDs) and patient-acceptable symptom state (PASS) thresholds. Health-care utilization outcomes included prolonged length of stay (LOS), nonhome discharge disposition (DD), mortality within one year, and others. A multivariable linear regression modeled predictors of PROMs and utilization outcomes. All tests were two-sided, with a significance level of 0.05. Despite lower median PROMs among HF patients at one year, similar proportions of patients who have and do not have HF achieved HOOS minimal clinically important differences. However, greater proportions of HF patients failed to achieve PASS thresholds for HOOS-Pain (P = 0.006), HOOS-Physical Function (P = 0.003), and HOOS-Joint Replacement (P = 0.005). Also, greater proportions of HF patients experienced length of stay (P < 0.001), discharge disposition (P < 0.001), and mortality within one year (P < 0.001). Heart failure, but not EF%, was a significant predictor of length of stay (P < 0.001), discharge disposition (P = 0.003), and 1-year mortality (P = 0.008). Despite lower PROMs and increased utilization, HF patients, like non-HF patients, can expect perceived improvements in pain and function after THA. While HF predicted healthcare utilization, EF% was not associated with these outcomes.