Recurrent heart failure hospitalizations are associated with increased cardiovascular mortality in patients with heart failure in Clinical Practice Research Datalink

Abstract

Aims Heart failure (HF) is a leading cause of hospitalization and is associated with high morbidity and mortality postdiagnosis. Here, we examined the impact of recurrent HF hospitalization (HFH) on cardiovascular (CV) and all-cause mortality among HF patients. Methods and Results Adult HF patients identified in the Clinical Practice Research Datalink with a first (index) hospitalization due to HF recorded in the Hospital Episode Statistics data set from January 2010 to December 2014 were included. Patients were followed up until death or end of study (December 2017). CV mortality as primary and as any reported cause and all-cause mortality were evaluated. An extended Cox regression model was used for reporting adjusted relative CV mortality rates for time-dependent recurrent HFHs. Overall, 8603 HF patients with an index hospitalization were included, providing 15 964 patient-years of follow-up. Patients were relatively old (median age: 80 years) and were mostly male (54.6%), with main co-morbidities being hypertension and atrial fibrillation. Recurrent HFHs occurred one, two, three, and more than four times in 1561 (18.2%), 518 (6.02%), 206 (2.4%), and 153 (1.8%) patients, respectively. The median time to mortality was 215 (38-664) days for 50.8% of patients who died for any cause during the study period and 139 (27-531) days for 31.3% who died with CV reasons as primary cause. Compared with those of patients without recurrent HFHs, the adjusted hazard ratios (95% CI) for CV mortality as primary cause were 2.65 (2.35-2.99), 3.69 (3.06-4.43), 5.82 (4.48-7.58), and 5.95 (4.40-8.05) for those with one, two, three, and more than four recurrent HFHs. Conclusions There is a strong association between recurrent HFH and CV mortality, with the risk increasing progressively with each recurrent HFH.

Recurrent hospitalizations are associated with increased mortality across the ejection fraction range in heart failure

“…The relationship was consistent between the HF subgroups. The relationship between history of prior hospitalizations and increased risk of mortality has been observed before in HF patients, both in clinical trials and in real‐world data 18,22–25 . However, studies to date have mainly focused on overall HF patients, with a paucity of data specific to HFpEF and HFmrEF.…”

“…The relationship between history of prior hospitalizations and increased risk of mortality has been observed before in HF patients, both in clinical trials and in real-world data. 18,[22][23][24][25] However, studies to date have mainly focused on overall HF patients, with a paucity of data specific to HFpEF and HFmrEF. In a recent observational study utilizing a large cohort of HF patients of the Clinical Practice Research Datalink database in the UK, the increased risk of CV mortality with rehospitalizations was shown in HF patients as a group, with an increase in HR of 2.8-6.3 for the first, second, and fourth rehospitalizations (21).…”

“…Therefore, it is important to increase the understanding of HF outcomes and mortality across different phenotypes, in particular the less well‐understood HFpEF, both to support the development of new treatments and to help with predicting and managing increasing health care costs. Previous studies have investigated the relationship between cardiovascular (CV) hospitalizations and mortality in HF; however, these have mainly assessed HF patients as an overall group or had a limited number of HFpEF patients in the analyses 18,20,22–25 . Furthermore, the knowledge on Finnish HF patients has remained limited.…”

“…Previous studies have investigated the relationship between cardiovascular (CV) hospitalizations and mortality in HF; however, these have mainly assessed HF patients as an overall group or had a limited number of HFpEF patients in the analyses. 18,20,[22][23][24][25] Furthermore, the knowledge on Finnish HF patients has remained limited.…”

Factors Associated with Adverse Cardiovascular Events in Cancer Patients Treated with Bevacizumab

“…While a number of studies have recorded various bevacizumab-associated toxicities [ 5 ], almost none have focused on predictors of cardiovascular admissions associated with those toxicities. Repeated cardiovascular-related hospitalizations are well associated with poor outcomes [ 9 ], and concerted efforts need to be made to understand and then mitigate the factors that lead to those in cancer patients. Better understanding of the impact of patients’ comorbidities on the development of major cardiovascular adverse events and hospitalization is critical to guide efforts to minimize these adverse outcomes.…”