Admission-to-discharge temperature reduction in decompensated heart failure is associated with rehospitalization.

Abstract

Decreasing body temperature on first follow-up visit-relative to discharge-predicts early rehospitalization in heart failure (HF). We studied whether admission-to-discharge temperature reductionwasassociated with increased HF rehospitalizationin the ESCAPE trial. We comparedpatients with or without ≥1 °C decrease intemperature from admission-to-discharge. The study endpoint was rehospitalization due to HF for up to 6months after discharge. Among 354 patients (averageage 57years, 73% men) with recorded admission and discharge temperature, 22 (6.2%) had an admission-to-discharge temperature reduction ≥1 ºC. Patients with admission-to-discharge temperature reduction ≥1 ºC had higher frequency of rehospitalization for HF (68.2% vs. 44.3%, estimated odds ratio [OR]2.697, 95% confidence interval [CI] 1.072-6.787, P= 0.029) despite asignificantly higher admission temperature. On multivariate analysis, admission-to-discharge temperature reduction ≥1 ºCpredictedrehospitalization for HF (OR2.02, 95% CI 1.028-3.966, P= 0.041) after adjustment for age, BMI, baseline Na, creatinine, ejection fraction and discharge NYHA class. Astandard logistic model treating temperature change as acontinuous variable, and amodel using arestricted cubic spline, did not demonstrate astatistically significant relationship between temperature reduction and HF rehospitalization.Subsequently, analtered logistic modelwas fit expressing the log odds of HF rehospitalization as apiecewise linear function of temperature decrease; this model did demonstrate statistical significance (P= 0.013) with an estimated odds ratio of 1.140 per 0.1 ºC beyond 0.5 ºC. Admission-to-discharge temperature reduction ≥1 ºC is an unfavorable prognostic sign associated with future rehospitalization due to HF.