Clinical presentation at first heart failure hospitalization does not predict recurrent heart failure admission

Abstract

AimsThere are limited data on whether clinical presentation at first heart failure (HF) hospitalization predicts recurrent HF events. We aimed to assess predictors of recurrent HF hospitalizations in mild HF patients with an implantable cardioverter defibrillator or cardiac resynchronization therapy with defibrillator.Methods and resultsData on HF hospitalizations were prospectively collected for patients enrolled in MADIT‐CRT. Predictors of recurrent HF hospitalization (HF2) after the first HF hospitalization were assessed using Cox proportional hazards regression models including baseline covariates and clinical presentation or management at first HF hospitalization. There were 193 patients with first HF hospitalization, and 156 patients with recurrent HF events. Recurrent HF rate after the first HF hospitalization was 43% at 1 year, 52% at 2 years, and 55% at 2.5 years. Clinical signs and symptoms, medical treatment, or clinical management of HF at first HF admission was not predictive for HF2. Baseline covariates predicting recurrent HF hospitalization included prior HF hospitalization (HR = 1.59, 95% CI: 1.15–2.20, P = 0.005), digitalis therapy (HR = 1.58, 95% CI: 1.13–2.20, P = 0.008), and left ventricular end‐diastolic volume >240 mL (HR = 1.62, 95% CI: 1.17–2.25, P = 0.004).ConclusionsRecurrent HF events are frequent following the first HF hospitalization in patients with implanted implantable cardioverter defibrillator or cardiac resynchronization therapy with defibrillator. Neither clinical presentation nor clinical management during first HF admission was predictive of recurrent HF. Prior HF hospitalization, digitalis therapy, and left ventricular end‐diastolic volume at enrolment predicted recurrent HF hospitalization, and these covariates could be used as surrogate markers for identifying a high‐risk cohort.

Outcomes at one year in women with peripartum cardiomyopathy: Findings from the ESC EORP PPCM Registry

“…two or more) were infrequent, occurring in 3% of women by 1 year. In chronic heart failure (with reduced ejection fraction) trial populations, approximately 5% of patients have at least two hospitalizations, 18 but in observational studies and in patients recently hospitalized with heart failure, repeated readmissions are more common, and may occur in as many as 40–50% of patients 19,20 . Recurrent hospitalizations have been shown to occur less frequently in women than in men, 18,21 and this, along with the high rates of recovery may, in part, explain the lower incidence.…”

Improved 30 day heart failure rehospitalization prediction through the addition of device‐measured parameters

“…A review of 30 day rehospitalization models reveals that most are of limited usefulness, with only modest discrimination between patients with and without imminent rehospitalizations after discharge from an index event. [6][7][8] Even the CMS administrative model used for evaluating excessive HF-related rehospitalization rates displays a c-statistic of only 0.60. 6 Clinical models are typically comprised of many variables, including patient demographics (e.g.…”