Lifetime Analysis of Hospitalizations and Survival of Patients Newly-Admitted with Heart Failure.
Circ Heart Fail. 2012 May 2;
Authors: Chun S, Tu JV, Wijeysundera HC, Austin PC, Wang X, Levy D, Lee DS
BACKGROUND: -Hospital readmissions for heart failure (HF) contribute to increased morbidity and resource burden. Predictors of hospitalization and patterns of cardiovascular events over the lifetime of HF patients have not been elucidated. METHODS AND RESULTS: -We examined recurrent hospitalizations, cardiovascular events, and survival among patients newly-discharged (April 1999-March 2001) with HF in the Enhanced Feedback For Effective Cardiac Treatment Phase 1 study. During 10-year follow-up, we examined all new cardiovascular hospitalizations and selected predictors of readmission. Among 8543 patients (mean age 77.4 ± 10.5 years, 51.6% women) followed for 22,567 person-years, 60.7% were ischemic etiology and HFrEF (left ventricular ejection fraction ?45% vs. >45% [HFpEF]) was present in 67.3%. Overall 10-year mortality was 98.8%, with 35,966 hospital readmissions occurring over the cohort's lifetime. Adjusted hazards ratios (HR) for first cardiovascular hospitalization were 1.36 for ischemic HF (95%CI; 1.28-1.44, p<0.001), 1.10 for HFrEF (95%CI; 1.00-1.20, p=0.045), and 1.00 for men (95%CI; 0.94-1.06, p=0.979). On repeated events time-to-event analysis, ischemic HF was a predictor of cardiovascular (HR 1.24, 95%CI; 1.18-1.29), HF (HR 1.20, 95%CI; 1.13-1.27) and coronary heart disease (HR 2.01, 95%CI; 1.81-2.24) hospitalizations (all p<0.001). Of all recurrent HF hospitalizations, 26.8% occurred in the first and 39.8% in the last deciles of cohort survival duration. Similarly, 29.7% and 52.3% of all cardiovascular readmissions occurred in the first and last deciles of the cohort survival duration, respectively. CONCLUSIONS: -Among newly-discharged HF patients, cardiovascular events were clustered at early post-discharge and pre-fatal time periods, and were increased among those with ischemic etiology.
PMID: 22556322 [PubMed - as supplied by publisher]