{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T18:39:44Z","timestamp":1792521584191,"version":"4.5.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Population Health and Outcomes"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Conventional postdischarge monitoring for heart failure (HF) with reduced ejection fraction focuses on readmission and mortality, but these end points may not summarize cumulative patient-centered health. We examined whether secular trends in conventional end points translated into improved days alive and out of hospital (DAOH), and whether trends differed by age, sex, and ethnicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Using the Singapore Cardiovascular Longitudinal Outcomes Database, we conducted a population-based cohort study of patients discharged alive after first HF with reduced ejection fraction hospitalization during 2011 to 2019. We estimated risk-adjusted annual trends in 30-day and 1-year DAOH, all-cause and HF-specific readmission, and all-cause and cardiovascular mortality, and tested trend heterogeneity by age, sex, and ethnicity with multiplicity adjustment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 10\u2009147 patients (median age, 68.9 years; 31.5% women; 65.4% Chinese; 20.0% Malay), risk-adjusted 30-day DAOH did not change materially (annual change, 0.01 [95% CI, \u22120.03 to 0.05] d\/y;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      -trend=0.554), whereas 30-day HF-specific readmission declined, with no change in 30-day all-cause readmission, all-cause mortality, or cardiovascular mortality. In contrast, 1-year DAOH improved from 291.7 to 301.0 days (1.16 [95% CI, 0.57\u20131.75] d\/y;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      -trend &lt;0.001). In parallel, 1-year HF-specific readmission, all-cause mortality, and cardiovascular mortality declined, while 1-year all-cause readmission remained stable. Improvements were not uniform across population subgroups. Declines in HF-specific readmission were steeper in men than women at 30 days and 1 year, and 1-year DAOH gains were greater among Malay than Chinese patients after multiplicity adjustment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Improvement was seen in 1-year but not 30-day DAOH after first HF with reduced ejection fraction hospitalization, alongside reductions in 1-year HF-specific readmission, all-cause mortality, and cardiovascular mortality. Dissimilar slopes highlight potentially inequitable benefits. DAOH may provide a patient-centered complement to conventional end points for monitoring burden and equity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circoutcomes.126.013579","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T09:00:36Z","timestamp":1786698036000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Shifting From Event Rates to Time at Home After Hospitalization for Heart Failure With Reduced Ejection Fraction: Trends and Equity in Days Alive and Out of Hospital in Singapore"],"prefix":"10.1161","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9850-319X","authenticated-orcid":true,"given":"Sibo","family":"Liu","sequence":"first","affiliation":[{"name":"Health Services Research &amp; Population Health (HSRPH) (S.L., N.G., S.S., S.K.), Duke-NUS Medical School, Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5559-3267","authenticated-orcid":true,"given":"Nicholas","family":"Graves","sequence":"additional","affiliation":[{"name":"Health Services Research &amp; Population Health (HSRPH) (S.L., N.G., S.S., S.K.), Duke-NUS Medical School, Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9164-6736","authenticated-orcid":true,"given":"Audry Shan Yin","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5601-3167","authenticated-orcid":true,"given":"Chun Fan","family":"Lee","sequence":"additional","affiliation":[{"name":"Centre for Biomedical Data Science (CBDS) (C.F.L.), Duke-NUS Medical School, Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5606-2046","authenticated-orcid":true,"given":"Sameera","family":"Senanayake","sequence":"additional","affiliation":[{"name":"Health Services Research &amp; Population Health (HSRPH) (S.L., N.G., S.S., S.K.), Duke-NUS Medical School, Singapore, Singapore."},{"name":"Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane (S.S., S.K.)."},{"name":"Cardiovascular Disease National Collaborative Enterprise, Singapore (S.S., D.J.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0389-7450","authenticated-orcid":true,"given":"Mark Yan Yee","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre, National University Health System, Singapore (M.Y.Y.C.)."},{"name":"Yong Loo Lin School of Medicine, National University of Singapore (M.Y.Y.C., D.J.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5457-4881","authenticated-orcid":true,"given":"Khung Keong","family":"Yeo","sequence":"additional","affiliation":[{"name":"Cardiovascular Sciences Academic Clinical Program (K.K.Y.), Duke-NUS Medical School, Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0729-4956","authenticated-orcid":true,"given":"Derek John","family":"Hausenloy","sequence":"additional","affiliation":[{"name":"Cardiovascular &amp; Metabolic Disorders Program (D.J.H.), Duke-NUS Medical School, Singapore, Singapore."},{"name":"Cardiovascular Disease National Collaborative Enterprise, Singapore (S.S., D.J.H.)."},{"name":"Yong Loo Lin School of Medicine, National University of Singapore (M.Y.Y.C., D.J.H.)."},{"name":"The Hatter 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