Predictors of Post-discharge Mortality Among Patients Hospitalized for Acute Heart Failure

Abstract

Acute Heart Failure (AHF) is a " multi-event disease" and hospitalisation is a critical event in the clinical course of HF. Despite relatively rapid relief of symptoms, hospitalisation for AHF is followed by an increased risk of death and re-hospitalisation. In AHF, risk stratification from clinically available data is increasingly important in evaluating long-term prognosis. From the perspective of patients, information on the risk of mortality and re-hospitalisation would be helpful in providing patients with insight into their disease. From the perspective of care providers, it may facilitate management decisions, such as who needs to be admitted and to what level of care (i.e. floor, step-down, ICU). Furthermore, risk-stratification may help identify patients who need to be evaluated for advanced HF therapies (i.e. left-ventricle assistance device or transplant or palliative care), and patients who need early a post-discharge follow-up plan. Finally, risk stratification will allow for more robust efforts to identify among risk markers the true targets for therapies that may direct treatment strategies to selected high-risk patients. Further clinical research will be needed to evaluate if appropriate risk stratification of patients could improve clinical outcome and resources allocation.

Association of Previous Hospitalization for Heart Failure With Increased Mortality in Patients Hospitalized for Acute Decompensated Heart Failure

“…The main findings of the present study are as follows: (1) previous history of HF hospitalization in patients hospitalized for ADHF was associated with a higher risk for mortality;…”

Management and Prognosis of Heart Failure in Octogenarians: Final Report from the KorAHF Registry

“…The survival benefit of beta blockade was more evident in patients surviving the first month after discharge. This could be explained by the fact that the rate of early mortality is especially high in elderly patients [31], and that beta-blockers were added on during the early follow-up periods. A previous study in chronic HF patients also reported that a quarter of admitted HF patients stopped beta-blockers or reduced their dosage at discharge due to hypotension of use of inotropes [32].…”

Improving Postdischarge Outcomes in Acute Heart Failure

“…A comprehensive assessment in these patients is necessary to identify prognostic characteristics that may become possible therapeutic targets. In RCTs and registries, the predictive factors for post-discharge mortality included age, history of previous hospitalization, congestion, systolic blood pressure, heart rate, QRS duration, renal function, markers of organ injury, and non-cardiac comorbidities (such as diabetes, cerebrovascular disease, chronic obstructive pulmonary disease, liver cirrhosis, and iron deficiency)(97).…”