Readmissions, Death and Its Associated Predictors in Heart Failure With Preserved Versus Reduced Ejection Fraction

Abstract

Background Data on rehospitalizations for heart failure (HF) in Asia are scarce. We sought to determine the burden and predictors of HF (first and recurrent) rehospitalizations and all‐cause mortality in patients with HF and preserved versus reduced ejection fraction (preserved EF, ≥50%; reduced EF, <40%), in the multinational ASIAN‐HF (Asian Sudden Cardiac Death in Heart Failure) registry. Methods and Results Patients with symptomatic (stage C) chronic HF were followed up for death and recurrent HF hospitalizations for 1 year. Predictors of HF hospitalizations or all‐cause mortality were examined with Cox regression for time to first event and other methods for recurrent events analyses. Among 1666 patients with HF with preserved EF (mean age, 68±12 years; 50% women), and 4479 with HF with reduced EF (mean age, 61±13 years; 22% women), there were 642 and 2302 readmissions, with 28% and 45% attributed to HF, respectively. The 1‐year composite event rate for first HF hospitalization or all‐cause death was 11% and 21%, and for total HF hospitalization and all‐cause death was 17.7 and 38.7 per 100 patient‐years in HF with preserved EF and HF with reduced EF, respectively. In HF with preserved EF, consistent independent predictors of these clinical end points included enrollment as an inpatient, Southeast Asian location, and comorbid chronic kidney disease or atrial fibrillation. The same variables were predictive of outcomes in HF with reduced EF except atrial fibrillation, and also included Northeast Asian location, older age, elevated heart rate, decreased systolic blood pressure, diabetes, smoking, and non‐usage of beta blockers. Conclusions One‐year HF rehospitalization and mortality rates were high among Asian patients with HF. Predictors of outcomes identified in this study could aid in risk stratification and timely interventions. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01633398.

One‐year trajectories of self‐care behaviours and unplanned hospital readmissions among patients with heart failure: A prospective longitudinal study

“…Two recent reviews emphasised that regular screening tests and multifactorial approach are required to improve self-care abilities and clinical outcomes in individuals with HF and cognitive impairment (Faulkner et al, 2021;Zhang, Jie, et al, 2022). According to the previous studies, health literacy and frailty were significantly associated with selfcare behaviours and hospital readmissions in patients with HF Tay et al, 2021). Patients with limited health literacy would not completely apply health information into their daily selfcare, which can lead to readmissions (Son & Won, 2020a, 2020b.…”

“…• Timely, targeted interventions for patients with a lowsustained self-care behaviours pattern while considering physical and mental status may help prevent unpredictable hospital readmissions of patients with HF. mellitus, atrial fibrillation and anaemia, are associated with self-care behaviours and/or hospital readmissions (Boyde et al, 2018;Tay et al, 2021). Besides common factors such as sociodemographic and clinical characteristics, cognitive impairment may affect longterm self-care behaviours and unplanned hospital readmissions.…”

“…Despite advances in HF treatment including medical therapy, HF‐related readmissions remain challenging, although nearly one quarter of unplanned HF‐related readmissions are avoidable (Tay et al, 2021; Wideqvist et al, 2021). Frequent hospital readmissions are related to the deterioration of quality of life and a higher risk of mortality, and incur a large portion of financial burden in HF care (Savarese et al, 2022).…”

“…Unpredictable and progressive HF conditions can lead to unplanned hospital readmissions, which can confer a high burden, including worse quality of life, an increased morality risk and increased healthcare costs (Savarese et al, 2022; Wideqvist et al, 2021). Despite recent advances in HF treatment, the 30‐day and 6‐month readmissions rates after hospital discharge range from 20% to 50% (Naderi et al, 2022; Tay et al, 2021). Therefore, early evaluation and the development of an individualised care plan for these highly vulnerable patients are required for reducing the HF readmissions rates.…”

“…Many studies of patients with HF have reported that sex, older age, low socioeconomic status, New York Heart Association (NYHA) functional class and comorbidities, such as hypertension, diabetes mellitus, atrial fibrillation and anaemia, are associated with self‐care behaviours and/or hospital readmissions (Boyde et al, 2018; Tay et al, 2021). Besides common factors such as sociodemographic and clinical characteristics, cognitive impairment may affect long‐term self‐care behaviours and unplanned hospital readmissions.…”