Multi-state Modeling of thr Hospitalizations Process of Patients affected by Chronic Heart Failure

In chronic diseases like Heart Failure (HF), often more than one type of event plays a role and more than one outcome has to be considered for a proper modeling of the disease progression. Accounting jointly for outcomes and events provides more detailed information on the disease-control process, and allows for a more precise understanding of the prognosis of patients, enabling people in charge of healthcare planning to assess and predict more accurately the impact and the costs of the disease of interest. We propose the use of two different multi-state models for the joint analysis of outcomes and events related to HF-patients, whose data come from the administrative databank of an Italian regional district (Lombardia). The aim is to point out a flexible approach that is able to catch important features of disease progression, such as multiple ordered events and distinction between the clinical events of death and hospitalizations, accommodating for competing risks.