Abstract
Background: Left atrial hypertension results in pulmonary hypertension which is a frequent finding in the setting of left ventricular failure. We hypothesized that noninvasive measurement of systolic pulmonary artery pressure (SPAP) by echocardiography could be used to estimate the risk of hospital readmission in patients with congestive heart failure (CHF). Methods: We conducted a retrospective cohort study on patients discharged from a major urban hospital between June 2009 and October 2009 with a primary diagnosis of CHF. Noninvasive assessment of SPAP by 2D echocardiography performed within 6 months preceding hospital discharge was among the inclusion criteria. A SPAP of 40 mmHg or greater in addition to other factors potentially predictive of re-hospitalization were included in a univariable cox-regression analysis for predicting all-cause readmission. Variables with p-values less than 0.25 were allowed to participate in a stepwise cox-regression model which identified all statistically significant predictors within a mutlivariable setting. Results: 145 patients participated in the stepwise cox-regression analysis. The mean SPAP (mmHg) was 47 with a median of 46. The following statistically significant predictors were identified: hemoglobin nadir < 10 g/dl (HR 1.63; 95% CI 1.07-2.48; P = 0.02), requirement of skilled nursing care after discharge (HR 1.73; 95% CI 1.14-2.63; P = 0.011), diagnosis of COPD (HR 1.62; 95% CI 1.04-2.51; P = 0.03), diagnosis of ESRD (HR 2.05; 95% CI 1.18-3.55; P = 0.01), use of cardiac resynchronization therapy (HR 4.71; 95% CI 1.95-11.35; P < 0.001) and SPAP of 40 or above (HR 2.03; 95% CI 1.30-3.18; P = 0.002). Conclusions: Previous limited studies have suggested that pulmonary hypertension is a prognostic marker in patients with cardiomyopathy. Our data suggests that noninvasive measurement of SPAP by echocardiography can help to predict the risk of hospital readmission in patients hospitalized for CHF. A systolic PAP of 40 mmHg or above appears to be a stronger predictor of re-hospitalization when compared to traditional risk factors including COPD, ESRD and anemia.
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