Hospitalizations After Heart Failure Diagnosis

Abstract

Objective To determine the lifetime burden and risk factors for hospitalization after heart failure (HF) diagnosis in the community. Background Hospitalizations in patients with HF represent a major public health problem, however the cumulative burden of hospitalizations after HF diagnosis is unknown, and no consistent risk factors for hospitalization have been identified. Methods We validated a random sample of all incident HF cases in Olmsted County, Minnesota from 1987–2006 and evaluated all hospitalizations after HF diagnosis through 2007. International Classification of Diseases, 9th Revision codes were used to determine the primary reason for hospitalization. To account for repeated events, Andersen-Gill models were used to determine the predictors of hospitalization after HF diagnosis. Patients were censored at death or last follow-up. Results Among 1077 HF patients (mean age 76.8 years, 582 [54.0%] female), 4359 hospitalizations occurred over a mean follow-up of 4.7 years. Hospitalizations were common after HF diagnosis, with 895 (83.1%) patients hospitalized at least once, and 721 (66.9%), 577 (53.6%) and 459 (42.6%) hospitalized ≥2, ≥3, and ≥4 times, respectively. The reason for hospitalization was HF in 713 (16.5%) hospitalizations, other cardiovascular in 936 (21.6%), while over half (n=2679, 61.9%) were non-cardiovascular. Male sex, diabetes mellitus, chronic obstructive pulmonary disease, anemia, and creatinine clearance <30 mL/min were independent predictors of hospitalization (p<0.05 for each). Conclusions Multiple hospitalizations are common after HF diagnosis, though less than half are due to cardiovascular causes. Comorbid conditions are strongly associated with hospitalizations, information that could be used to define effective interventions to prevent hospitalizations in HF patients.

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

“…Chociaż nasilenie objawów zazwyczaj słabo koreluje z większością parametrów opisujących funkcję LV, to jednak istnieje prosty związek między nasileniem objawów a przeżyciem odległym. Nawet u pacjentów z łagodnie nasilonymi objawami istnieje zwiększone ryzyko hospitalizacji i zgonu [8][9][10].…”

Budget Impact of Adding Ivabradine to Standard of Care in Patients with Chronic Systolic Heart Failure in the United States

“…Prognosis for patients with HF remains relatively poor, with the 5-year survival rate estimated to be approximately 50% (3). In addition, HF is associated with a substantial economic burden, mainly because patients require frequent hospitalization, especially those with severe HF not controlled by standard medication (4). In 2010, direct medical costs associated with HF in the United States (US) were estimated to be approximately $21 billion, 80% of which was directly attributable to hospitalizations (1,5).…”

Variations in heart failure hospitalisation rates by socioeconomic status, Victoria, Australia

“…In one study (of a sample of 192,327 adults hospitalised for HF) from the United States, 82.4% had comorbidities, an average of 7.5 comorbidities per patient. Among a sample of 1,077 HF patients (54% female) in Olmsted County, Minnesota, Dunlay et al [9] found that HF was the reason for hospitalisation in 16.5%, other cardiovascular conditions in 21.6% and non-cardiovascular conditions in 61.9%. The latter included chronic obstructive pulmonary disease (COPD), musculoskeletal conditions, renal failure, diabetes mellitus and gastrointestinal conditions.…”

“…The latter included chronic obstructive pulmonary disease (COPD), musculoskeletal conditions, renal failure, diabetes mellitus and gastrointestinal conditions. Dunlay et al [9] showed that the univariate predictors of HF hospitalisation included COPD, diabetes and decreased renal function. Hu et al [7] reported that patients hospitalised for HF with certain comorbidities had significantly higher readmission rates.…”