Patients with cardiac amyloidosis are at a greater risk of mortality and hospital readmission after acute heart failure

Abstract

Aims Cardiac amyloidosis (CA) is an under-diagnosed cause of heart failure (HF) and has a worse prognosis than other forms of HF. The frequency of death or rehospitalization following discharge for acute heart failure (AHF) in CA (relative to other causes) has not been documented. The study aims to compare hospital readmission and death rates 90 days after discharge for AHF in patients with vs. without CA and to identify risk factors associated with these events in each group. Methods and resultsPatients with HF and CA (HF + CA+) were recruited from the ICREX cohort, after screening of their medical records. The cases were matched 1:5 by sex and age with control HF patients without CA (HF + CAÀ). There were 27 HF + CA + and 135 HF + CAÀ patients from the ICREX cohort included in the study. Relative to the HF + CAÀ group, HF + CA+ patients had a higher heart rate (P = 0.002) and N-terminal prohormone of brain natriuretic peptide levels (P < 0.001) and lower blood pressure (P < 0.001), weight, and body mass index values (P < 0.001) on discharge. Ninety days after discharge, the HF + CA+ group displayed a higher death rate, a higher all-cause hospital readmission rate, and a higher hospital readmission rate for AHF. Death and hospital readmissions occurred sooner after discharge in the HF + CA+ group than in the HF + CAÀ group. Conclusions The presence of CA in patients with HF was associated with a three-fold greater risk of death and a two-fold greater risk of all-cause hospital readmission 90 days after discharge. These findings emphasize the importance of close, active management of patients with CA and AHF.

Editors' highlight picks from 2023 in ESC heart failure

“…9 Cardiac amyloidosis is an under-diagnosed cause of HF and has a worse prognosis than other forms of HF: It is associated with a three-fold greater risk of death and a two-fold greater risk of all-cause hospital readmission 90 days after discharge. 10 In patients with chronic coronary syndrome (CCS), the incidence of HF is comparable with the incidence of myocardial infarction or stroke, but the mortality risk attributable to new-onset HF is more than 2.5-fold. 11…”