Characteristics, outcomes, and predictors of 1-year mortality in patients hospitalized for acute heart failure (original) (raw)
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Multidisciplinary Cardiovascular Annals
Background: Mortality, morbidity and the burden of the advanced heart failure and also the cost of frequent admissions is high. Several registries were done all over the world to manage the patients with heart failure; however studies about the advanced stage are limited. Objectives: The present study aimed to determine the prognostic predictors of patients with advanced heart failure. Methods: In this study 178 (74.2% male) patients with advanced heart failure (stage D) from 2011 to 2016 were selected according to the following inclusion criteria; highly symptomatic heart failure patients with severe left ventricular (LV) systolic dysfunction (LV ejection fraction less than 30%) who have been admitted for at least two times in the recent year because of decompensation. The data regarding the clinical findings, readmissions, mortality, laboratory tests, electrocardiography, echocardiography, etc. of patients were all derived from Rajaie Acute Systolic Heart Failure (RASHF) data registry. Results: In a 5-year follow-up, we realized that more than 70% of the patients died. The rate of mortality were significantly higher in females (P value = 0.006) and there was a significant correlation between anemia and the mortality (P value = 0.002). There was no remarkable association between the serum creatinine, sodium and uric acid levels with the mortality of the patients. Conclusions: Data about stage D of heart failure are limited. The mortality rate for such patients is relatively high and there's no clear best treatment approach. Large registries and data acquisition of these patients could be helpful for better management approaches.
Heart failure in patients admitted to hospital: mortality is still high
European Journal of Internal Medicine, 2002
Introduction: How to handle blood pressure in very elderly patients (> 80 years) is still debatable. Many are frail, dependent, and susceptible to drug interactions, and have not been included in blood pressure trials. Thus, how blood pressure levels in these patients predict future events remains unclear. Methods: We studied a cohort of 339 elderly patients with a mean age of 83 years that visited the emergency department and were subsequently admitted into the hospital. We divided the cohort into two groups: 144 patients with blood pressure ≥ 140/90 mm Hg (HBP-group) and 195 patients with blood pressure < 140/90 mm Hg (NBP-group). Mean blood pressure in the HBP-group was 158/83 mm Hg and 122/70 mm Hg in the NBP-group. Furthermore, we also did a subgroup analysis on a total of 178 patients with heart failure, totaling 69 with high blood pressure with a mean of 155/85 mm Hg (HBP HF-group) and 109 without high blood pressure with a mean of 119/71 mm Hg (NBP HFgroup). Results: After 6 months 20 patients were dead in the HBP-group compared to 54 patients in the NBP-group (p < 0.01). In the subgroup analysis, 6 patients were dead in the HBP HF-group and 26 patients were dead in the NBP HF-group after 6 months (p = 0.01). Conclusions: We found that very elderly patients in general but also patients with heart failure in particular that presented with high blood pressure when enrolling into the hospital had significantly lower 6-month mortality than very elderly with normal blood pressure.
European Journal of Internal Medicine, 2016
Background: To assess the impact of comorbidities on long-term all-cause mortality in patients hospitalized with exacerbated signs/symptoms of previously chronic stable HF (AE-CHF). Methods: 1119 patients admitted for AE-CHF and with NT-proBNP levels N900 pg/mL were enrolled. Univariable and multivariable Cox analyses were performed to assess the association of age, gender, hypertension, diabetes, obesity, atrial fibrillation, coronary heart disease (CHD), chronic obstructive pulmonary disease, previous cerebrovascular accidents, chronic liver disease (CLD), thyroid disease, renal impairment (RI), and anemia with 3-year all-cause mortality. Results: During the follow-up, 441 patients died and 126 underwent heart transplantation (HT) or ventricular assist device (VAD) implantation. 45.8% of the fatal events and 52.4% of HT/VAD implantations occurred within 180 days after admission. Increasing age (p = .012), obesity (p = .037), atrial fibrillation (p = .030), CHD (p = .015), CLD (p = .001), RI (p b .001), and anemia (p b .001) were independently associated with 3-year all-cause mortality. Most of the prognostic impact of CHD, took place within the first 180 days after admission. Male gender was associated with mortality beyond 180 days. Compared with normal weight, obesity was associated with better overall survival. Obese patients, however, had significantly lower NT-proBNP concentrations and less frequently presented with hypotension, hyponatremia, and severe left ventricular systolic dysfunction, despite a similar prevalence of severe dyspnea at admission. Conclusions: Several comorbidities are associated with long-term risk of death in hospitalized patients with worsening HF, although the nature of this association does appear to be complex. Our data may help to raise awareness about the clinical relevance of comorbid conditions.
Predictors of 30-day mortality in patients admitted to ED for acute heart failure
The American Journal of Emergency Medicine, 2017
Objectives: Acute heart failure (AHF) is a leading cause of admission in emergency departments (ED). It is associated with significant in-hospital mortality, suggesting that there is room for improvement of care. Our aims were to investigate clinical patterns, biological characteristics and determinants of 30-day mortality. Methods: We conducted a single site, retrospective review of adult patients (≥18 years) admitted to ED for AHF over a 12-month period. Data collected included demographics, clinical, biological and outcomes data. Epidemiologic data were collected at baseline, and patients were followed up during a 30-day period. Results: There were a total of 322 patients. Mean age was 83.9 ± 9.1 years, and 47% of the patients were men. Among them, 59 patients (18.3%) died within 30 days of admission to the ED. The following three characteristics were associated with increased mortality: age N 85 years (OR = 1.5[95%CI:0.8-2.7], p = 0.01), creatinine clearance b30 mL/min (OR = 2.6[95%CI:1.4-5], p b 0.001) and Nt-proBNP N 5000 pg/mL (OR = 2.2[95%CI:1.2-4], p b 0.001). The best Nt-proBNP cutoff value to predict first-day mortality was 9000 pg/mL (area under the curve (AUC) [95%CI] of 0.790 [0.634-0.935], p b 0.001). For 7-day mortality, it was 7900 pg/mL (0.698 [0.578-0.819], p b 0.001) and for 30-day mortality, 5000 pg/mL (0.667 [0.576-0.758], p b 0.001). Conclusions: Nt-proBNP level on admission, age and creatinine clearance, are predictive of 30-day mortality in adult patients admitted to ED for AHF.
The short-term prognostic value of C-reactive protein in elderly patients with acute heart failure
Revista Clínica Española (English Edition), 2019
Introduction and objectives: Plasma c-reactive protein (CRP) has been tested as a prognostic marker in acute heart failure (AHF). Whether its measurement really provides significant prognostic information when applied to elderly patients with AHF episodes remains unclear. Methods: We measured the plasma CRP values of patients admitted because of any type of AHF to internal medicine services. We evaluated the association of these values with the patients' baseline clinical characteristics and their 3-month post-discharge all-cause mortality or readmission rates. For comparison purposes, we divided the sample in tertiles of low, medium and high CRP values (<2.24 mg/L, 2.25-11.8 mg/L and >11.8 mg/L). Results: We included 1443 patients with a median age of 80 years (interquartile range 73-85); 680 (47%) were men, with a moderate comorbid burden. 60.1% had preserved left ventricular ejection fraction (>50%). Multivariate analysis confirmed an independent association between higher CRP values and the presence of respiratory infection, lower systolic blood pressure and deteriorated renal function upon admission. Three months after the index admission, a total of 142 patients (9.8%) had died, and 268 (18.6%) had either been readmitted or died. admission CRP values did not correlate with 3-month all-cause mortality (p = 0.79), 3-month all-cause readmission (p = 0.96) or the combination of both events (p = 0.96). However, higher CRP values were associated with a longer length of stay (p < 0.001).
Revista Espanola De Cardiologia, 2006
Introduction and objectives. Most clinical trials that demonstrated the negative impact of renal failure on survival in patients with congestive heart failure (CHF) included a relatively small proportion of subjects with a high creatinine level and were performed in patients with depressed left ventricular systolic function. Our aim was to investigate the clinical characteristics and prognosis of hospitalized CHF patients with depressed or preserved systolic function and different degrees of renal dysfunction. Patients and method. The study included 552 consecutive CHF patients admitted to a hospital department of cardiology between 2000-2002. Renal function was determined from the estimated glomerular filtration rate (GFR), and patients were divided into three groups: GFR>60, GFR 30-60, and GFR<30 mL/min per 1.73 m 2 (severe renal failure), containing 56.5%, 35.5%, and 8.0% of patients, respectively. Results. Patients with severe renal failure had the worst cardiovascular risk profile: older age, higher prevalence of cardiovascular risk factors, anemia, inflammatory markers in plasma, and less prescription of angiotensin-converting enzyme (ACE) inhibitors. Survival in this patient group was significantly poorer than in other groups (relative risk or RR=2.4; 95% CI, 1.3-4.4) in those with either depressed (RR=3.8; 95% CI, 1.4-10.6) or preserved (RR=2.9; 95% CI, 1.2-6.9) systolic function, independent of other prognostic factors. The negative impact of severe renal failure on prognosis was reduced by ACE inhibitor use. Conclusions. Renal failure is common and a strong predictor of mortality in hospitalized CHF patients with or without depressed systolic function. It is associated with a worse risk profile.
Predictors of short term mortality in heart failure — Insights from the Euro Heart Failure survey
International Journal of Cardiology, 2010
Objective: To identify factors associated with short term mortality in hospitalised patients with heart failure. Background: Hospitalisation is frequent in patients with heart failure and is associated with a high mortality. Methods: The Euro Heart Failure survey collected data from patients with suspected heart failure. We searched this data for predictors of short term mortality. Results: Of 10,701 patients, 1404 (13%) died within 12 weeks of admission. On univariate analysis, increasing age, hyponatraemia, renal impairment, hyperkalaemia, anaemia, severe mitral regurgitation, severe LV systolic dysfunction(LVSD), increasing QRS and female sex carried adverse prognosis. ACEI, beta-blockers, nitrates, anti-thrombotic and lipid lowering drugs were associated with a better prognosis. On multivariable analysis the following provided independent prognostic information: increasing age (OR per SD = 1.5, 95% CI 1.4-1.6), severe LVSD (1.8, 1.5-2.1), serum creatinine (1.2, 1.2-1.3), sodium (0.9, 0.8-0.9), Hb (0.9, 0.8-0.9) and treatment with ACEI (0.5, 0.5-0.6), betablockers (0.7, 0.6-0.8), statins (0.6, 0.5-0.7), calcium channel blockers (0.7, 0.6-0.8), warfarin (0.5, 0.4-0.6), heparin (1.7, 1.4-1.9), antiplatelet drugs (0.6, 0.5-0.6) and need for inotropes (5.5, 4.6-6.6). A simple risk score (range 0-11) identified cohorts with a 12 week mortality ranging from 2% to 44%. Conclusions: Simple and readily available clinical variables and a risk score based on medical history and routine tests that all patients admitted with heart failure have, can identify patients with good, intermediate and high short term mortality.
Long-term Survival in Elderly Patients Hospitalized for Heart Failure
Archives of Internal Medicine, 2006
Background: The growing heart failure epidemic imposes a substantial burden on the US health care system. The ability to accurately assess prognosis would allow clinicians to triage patients to appropriate therapy and to plan the intensity of care following hospital discharge. Methods: A cohort of 282 elderly (mean ± SD age, 79.2 ± 6.1 years) patients with heart failure were followed for up to 14 years after enrollment in a prospective randomized multidisciplinary disease management trial conducted from 1990 through 1994. Kaplan-Meier survival curves were constructed to assess the probability of survival during the follow-up period. A Cox proportional hazards model was developed to identify independent predictors of long-term survival. C statistics were calculated to assess the utility of the model for predicting mortality at 6 months, 1 year, and 5 years. Results: During the 14-year follow-up period, 269 patients (95%) died and the median survival was 894 days. Cox analysis identified 7 variables that were independent predictors of shorter survival time: older age (hazard ratio [HR], 1.14 per 5 years; 95% confidence interval [CI], 1.03-1.26), serum sodium level less than 135 mEq/L (HR, 1.67; 95% CI, 1.19-2.32), coronary artery disease (HR 1.51; 95% CI, 1.16-1.95), dementia (HR, 2.02; 95% CI, 1.13-3.61), peripheral vascular disease (HR, 1.74; 95% CI, 1.20-2.52), systolic blood pressure (HR, 0.95 per 10 mm Hg; 95% CI, 0.92-0.98), and serum urea nitrogen level (HR, 1.20 per 10 mg/dL [3.57 mmol/L]; 95% CI, 1.12-1.29). C statistics for the model were 0.84, 0.79, and 0.75 at 6 months, 1 year, and 5 years, respectively. A risk score for mortality was developed using the 7 independent predictor variables. One-year mortality rates among patients with 0 to 1 (n=89), 2 to 3 (n=153), and 4 or more (n = 37) risk factors were 9.0%, 22.2%, and 73.0%, respectively (PϽ.001). Conclusions: Among elderly patients hospitalized with heart failure, median survival is about 2.5 years. However, there is considerable heterogeneity in survival, with 25% of patients dying within 1 year and 25% surviving for more than 5 years. A simple 7-item risk score, based on data readily available at the time of admission, provides a reliable estimate of prognosis.
European Journal of Heart Failure, 2006
Little is known about the epidemiology of acute decompensated heart failure (ADHF) in patients admitted to intensive and coronary care units (ICU/CCU). Observational data may improve disease management and guide the design of clinical trials. Aims: EFICA is an observational study of the clinical profile, management and survival of ADHF patients admitted to ICU/CCU. Methods: The study included 599 patients admitted to 60 ICU/CCUs across France. Relevant data was recorded during hospitalisation. Survival was assessed at 4 weeks and 1 year. Results: The main cause of ADHF was ischaemic heart disease (61%); 29% of patients had cardiogenic shock. Mortality was 27.4% at 4 weeks and 46.5% at 1 year, increasing to 43.2% and 62.5%, respectively, when including pre-admission deaths. Shock patients had the highest [57.8% vs. 15.2% without shock ( p < 0.001)] and patients with hypertension and pulmonary oedema had the lowest 4-week mortality: (7%). Pre-admission NYHA class III -IV heart failure, not initial clinical presentation, influenced 1-year mortality. Conclusion: ADHF is a heterogeneous syndrome. Based on initial clinical presentation, three entities with distinct features and outcome may be described: cardiogenic shock, pulmonary oedema with hypertension, and Fdecompensated_ chronic heart failure. This should be taken into account in future observational studies, guidelines and clinical trials.