Characteristics, Treatments, and Outcomes of Patients With Preserved Systolic Function Hospitalized for Heart Failure

Fonarow, Gregg C.; Stough, Wendy Gattis; Abraham, William T.; Albert, Nancy M.; Gheorghiade, Mihai; Greenberg, Barry; O’Connor, Christopher M.; Sun, Jie; Yancy, Clyde W.; Young, James B.; Investigators, Optimize-Hf; Hospitals,

doi:10.1016/j.jacc.2007.04.064

Cited by 941 publications

(761 citation statements)

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“…Renal failure and chronic respiratory diseases were predictors of poor outcomes. The percentage with co‐morbidities in our study is similar to other national and international studies,7, 20, 22 except for hypertension, which was lower in our study. However, there might be an under‐reporting of co‐morbidities or a lack of clear diagnostic criteria from administrative data collection 38.…”

Section: Discussionsupporting

confidence: 91%

“…showed 28 day and 1 year readmission or death rates of 32% and 72%, respectively. In the USA, the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure registry20 revealed 60–90 day event rates of 36.1% in HF with reduced ejection fraction (HFrEF) and 35.3% in HF with preserved ejection fraction (HFpEF). The high rate of primary outcome may be due to old age and the high prevalence of co‐morbidities 19.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes following heart failure hospitalization in a regional Australian setting between 2005 and 2014

et al. 2017

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AimsThe aim of the current study is to examine 10 year trends in mortality and readmission following heart failure (HF) hospitalization in metropolitan and regional Australian settings.Methods and resultsWe identified all index HF hospitalizations in the Hunter New England region from 2005 to 2014, using a 10 year ‘look back’ period. The primary endpoint was a composite of all‐cause mortality or all‐cause readmission at 1 year. Secondary endpoints included all‐cause mortality, all‐cause readmission, and HF readmission at 30 days and 1 year. We used logistic regression to explore the predictors of the composite outcome of either all‐cause death or readmission at 1 year. There were 12 114 patients admitted with a first episode of HF between 2005 and 2014, followed up until death or the end of 2015. The mean age was 78 ± 12 years and 49% (n = 5906) were male. A total of 4831 (40%) resided in regional areas and the remainder in metropolitan areas. One hundred sixty‐eight patients (1.4%) were Aboriginal. Approximately 69% of patients had either died or been readmitted for any cause within 12 months of their index event. The 30 day and 1 year all‐cause mortality rates were 13% and 32%, respectively, with no change in the trend over the study period. Age, socio‐economic disadvantage, ischaemic heart disease, renal failure, and chronic lower respiratory disease were predictors of the primary endpoint.ConclusionsHeart failure hospitalizations are followed by high rates of death or readmission. There was no change in this composite endpoint over the 10 year study period.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Outcomes following heart failure hospitalization in a regional Australian setting between 2005 and 2014

et al. 2017

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“…Given these baseline differences, LOS should have been shorter, as systolic blood pressure has been associated with a shorter LOS, lower hospital mortality, and lower 60-to 90-day mortality. 2,10,[27][28][29][30] Nevertheless, in our cohort we noted a longer hospital LOS in women, despite the higher presenting systolic blood pressure. The reason for the difference in LOS is uncertain: social determinants, biologic differences, and undertreatment of hypertension in women likely contribute to these findings.…”

Section: Discussionmentioning

confidence: 86%

Sex Differences in the Management and Outcomes of Heart Failure With Preserved Ejection Fraction in Patients Presenting to the Emergency Department With Acute Heart Failure

Zsilinszka

Shrader

DeVore

et al. 2016

Journal of Cardiac Failure

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Heart failure (HF) with preserved ejection fraction (HFpEF) represents 50% of the HF population. Although more common in women than men, there are limited data characterizing sex differences in the management and outcomes of HFpEF patients that present acutely to the emergency department (ED). Using data from the ADHERE-EM registry linked to Medicare claims, we conducted a retrospective analysis of patients presenting to the ED with acute HF. We identified patients with HFpEF (EF ≥40%) and stratified them by sex to compare baseline characteristics, ED therapies, hospital length of stay (LOS), in-hospital mortality, and postdischarge outcomes. We compared outcomes using Cox proportional hazards models and linear mixed models. Of 4161 patients with HFpEF, 2808 (67%) were women, and were typically older and more likely to have hypertension, but less likely to have diabetes or a smoking history (all p<0.01). Women were more likely than men to present to the ED with a systolic blood pressure >140mmHg (62.5% vs. 56.4%, p=0.0001), and also had a greater presenting EF. There were no sex differences in ED therapies, adjusted 30-and 180-day all-cause mortality, in-hospital mortality, or 30-and 180-day hospital readmissions. After adjusting for covariates, women had a longer hospital LOS (0.40 days; 95% CI 0.10, 0.70; p=0.008). Women with HFpEF presenting to the ED were more likely to have elevated systolic blood pressure, but overall ED management strategies were similar to men. We observed adjusted differences in hospital LOS, but no differences in 30-and 180-day outcomes.Key words: heart failure with preserved ejection fraction; sex differences in management; sex differences in outcomes 3 Heart failure (HF) is a major and increasing public health problem worldwide.HF affects more than 5 million Americans, leads to more than 1 million hospitalizations, and accounts for more than $30 billion in annual medical costs. 1 HF with preserved ejection fraction (HFpEF) represents approximately 50% of the HF population, and has adverse event rates similar to HF with reduced ejection fraction. 2 The emergency department (ED) is the primary setting where initial acute HF management takes place; more than 80% of acute HF patients who present to the ED are admitted. 3 Recent studies highlight differences in baseline characteristics and initial management strategies for men versus women presenting to the ED with all types of HF, including HFpEF and HF with reduced ejection fraction, 4-6 but it is unknown whether these differences hold true in the HFpEF population, and whether there are sex differences in shortand long-term outcomes in HFpEF patients following acute HF ED presentation.To address these issues, we used data from the Acute Decompensated HF National Registry Emergency Module (ADHERE-EM) database linked to Medicare claims to evaluate sex differences in patients with HFpEF that presented to the ED with acute HF, with regard to presentation, treatments, and outcomes. MethodsT h e ADHERE-EM registry enrolled patients th...

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“…Overall, 26% of patients in ADHERE did not have evidence of pulmonary congestion on their initial chest radiograph, and 50%-55% of patients in both registries had preserved systolic function. 13,[15][16][17] Consequently, attention has turned to biomarkers as a means of rapidly and accurately identifying ADHF. Serum B-type natriuretic peptide (BNP) and its N-terminal prohormone (NT-proBNP) have proven to be both diagnostic and prognostic indicators in ADHF.…”

Section: Recognition Of Adhfmentioning

confidence: 99%

Hospitalized patients with acute decompensated heart failure: Recognition, risk stratification, and treatment review

Amin¹

2008

J. Hosp. Med.

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Acute decompensated heart failure (ADHF) has emerged as a major healthcare problem. It causes approximately 3% of all hospitalizations in the United States, with the direct medical cost of these hospitalizations estimated at $18.8 billion per year. Early recognition, risk stratification, and evidence-based treatment are crucial in reducing the morbidity, mortality, and costs associated with this disorder. Classic signs and symptoms of ADHF, such as rales, dyspnea, and peripheral edema, may be absent at hospital presentation and, even when present, are not specific to this disorder. As a result, serum B-type natriuretic peptide level is now used to rapidly and accurately detect ADHF. Multivariate analyses have identified renal dysfunction, hypotension, advanced age, hyponatremia, and comorbidities as significant and independent mortality risk factors. Based on these factors, mortality risk can be stratified from very low to very high using published algorithms that have been validated in independent populations. Evidence-based guidelines for the treatment of ADHF are available from both the European Society of Cardiology and the Heart Failure Society of America. In general, an intravenous loop diuretic, either alone or in combination with a vasodilator, is recommended as initial therapy in patients with volume overload, depending on the patient's clinical status. Use of inotropic agents should be limited to the small subset of patients with low-output syndrome and significant hypotension. In any event, frequent monitoring of clinical response is essential, with subsequent therapy determined by this response. Finally, focused patient education during hospitalization may help reduce readmissions for ADHF. Journal of Hospital Medicine 2008;3(Suppl 6):S16-S24. V

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Characteristics, Treatments, and Outcomes of Patients With Preserved Systolic Function Hospitalized for Heart Failure

Cited by 941 publications

References 27 publications

Outcomes following heart failure hospitalization in a regional Australian setting between 2005 and 2014

Outcomes following heart failure hospitalization in a regional Australian setting between 2005 and 2014

Sex Differences in the Management and Outcomes of Heart Failure With Preserved Ejection Fraction in Patients Presenting to the Emergency Department With Acute Heart Failure

Hospitalized patients with acute decompensated heart failure: Recognition, risk stratification, and treatment review

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