Risk stratification after hospitalization for decompensated heart failure

On admission serum sodium and uric acid levels predict 30 day rehospitalization or death in patients with acute decompensated heart failure

“…Accordingly, a growing body of research is trying to characterize this population of patients who are at increased risk of early post‐discharge mortality and hospitalization. Presumed prognosticators comprise a wide range of history and physical examination findings, laboratory measurements, electrocardiographic and echocardiographic indices, and ultrasound assessments and include anaemia, diabetes mellitus, new sustained arrhythmias, non‐use of neurohormonal antagonists, presence of coronary heart disease (CHD), jugular venous distension, admission systolic blood pressure, serum albumin levels, lymphocyte counts, troponin release, blood urea nitrogen (BUN) and BUN/creatinine ratio, natriuretic peptides, 6‐min walk distance (6MWD), LVEF, pulmonary capillary wedge pressure, diameter of inferior vena cava, and diuretic response and hemoconcentration during hospitalization among many others 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28. However, there is no general consensus regarding the majority of these indices, and application of most of them is subject to several disadvantages in routine clinical practice.…”

Rehospitalization for Heart Failure

“…Renal impairment and worsening renal function during the course of heart failure hospitalization are increasingly recognized as potent predictors of adverse outcomes including readmission. 28 Associated diagnoses, including atrial fibrillation, ischemic heart disease, and hypertension, confer higher risk for cardiovascular admission, whereas the burden of comorbid noncardiac illness, 29 including chronic kidney disease, 30 diabetes mellitus, 31 anemia, 32 and pulmonary disease, raises the risk for both heart failure and non-heart failure-related complications. Beyond clinical and laboratory parameters, the overall level of disability as reflected in measures of functional limitation, frailty, 33 and patient-reported quality of life 34 seems to be a particularly important predictor of the overall readmission rate.…”

Prognostic factors in heart failure — are they all equally important?

“…Understandably, the abundance of those variables: 1) derives from complex pathophysiological pathways of HF development as well as from the fact that advanced HF affects function of other critical organs, and 2) denotes the need for more comprehensive means of assessment of prognosis in these patients because no single parameter is sufficient on its own. Thus, different risk scores, encompassing various numbers of predictive variables, have been proposed for risk stratification in HF [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. A recent meta-analysis reported as many as 117 models, using 249 different variables [20].…”

“…Different risk models were designed to assess different clinical endpoints, for example for patients with acute HF some models were developed for the estimation of in-hospital mortality (Table 2), some for the estimation of post-discharge mortality (e.g. EFFECT model [8], OPTIME-CHF model [9], ESCAPE risk score [10], ADHF/NT-proBNP risk score [11]), and some for the estimation of a composite endpoint including death, worsening HF, and HF rehospitalisation (e.g. PROTECT risk model [12]).…”

“…Other strong predictors of death in HF, consistently reported across different models, include diabetes, BNP/NT-proBNP concentration, weight or body mass index, and exercise capacity [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Of all prognostic variables, LVEF and NYHA class belong to the most useful and powerful predictors of long-term HF outcomes.…”