Days Of Heart Failure Hospitalization Research Articles

Suboptimal Cardiology Follow-Up Among Patients With and Without Cancer Hospitalized for Heart Failure

Many patients hospitalized for heart failure (HF) do not receive recommended follow-up cardiology care, and non-White patients are less likely to receive follow-up than White patients. Poor HF management may be particularly problematic in patients with cancer because cardiovascular co-morbidity can delay cancer treatments. Therefore, we sought to describe outpatient cardiology care patterns in patients with cancer hospitalized for HF and to determine if receipt of follow-up varied by race/ethnicity. SEER (Surveillance, Epidemiology, and End Results) data from 2007 to 2013 linked to Medicare claims from 2006 to 2014 were used. We included patients aged 66+ years with breast, prostate, or colorectal cancer, and preexisting HF. Patients with cancer were matched to patients in a noncancer cohort that included individuals with HF and no cancer. The primary outcome was receipt of an outpatient, face-to-face cardiologist visit within 30 days of HF hospitalization. We compared follow-up rates between cancer and noncancer cohorts, and stratified analyses by race/ethnicity. A total of 2,356 patients with cancer and 2,362 patients without cancer were included. Overall, 43% of patients with cancer and 42% of patients without cancer received cardiologist follow-up (p=0.30). After multivariable adjustment, White patients were 15% more likely to receive cardiology follow-up than Black patients (95% confidence interval [CI] 1.02 to 1.30). Black patients with cancer were 41% (95% CI 1.11 to 1.78) and Asian patients with cancer were 66% (95% CI 1.11 to 2.49) more likely to visit a cardiologist than their noncancer counterparts. In conclusion, less than half of patients with cancer hospitalized for HF received recommended follow-up with a cardiologist, and significant race-related differences in cardiology follow-up exist. Future studies should investigate the reasons for these differences.

Gender differences in the impact of frailty on 90-day hospital readmission in heart failure patients: a retrospective cohort study.

Frequent hospital readmissions after heart failure (HF) are common, however, there is limited data on the association between frailty status and hospital readmission in HF patients. This study aimed to examine the 90-day hospital readmission rates and gender differences in the impact of frailty on 90-day hospital readmission in HF patients. We retrospectively analysed hospital discharge records of 279 patients (men = 169, women = 110) who were diagnosed with HF between January 2017 and December 2018. Frailty was assessed using the Korean version of the FRAIL scale. A logistic regression analysis was conducted to explore the factors predicting 90-day hospital readmission by gender. The prevalence of frailty and 90-day hospital readmissions were ∼54.4% and 22.7% in women, compared with 45.6% and 27.8% in men, respectively. Frail patients with HF have an increased risk of 90-day hospital readmission in both males and females. Particularly, women with frailty had a higher risk of 90-day hospital readmission [adjusted odds ratio (OR) 6.72, 95% confidence interval (CI) 1.41-32.09] than men with frailty (adjusted OR 4.40, 95% CI 1.73-11.17). Our findings highlight that readmission within 90 days of hospitalization for HF can be predicted by patients' frailty. More importantly, we found that women with frailty have a greater risk of readmission than men with frailty. Screening for frailty should therefore be integrated into the assessment of HF patients. Tailored interventions for preventing adverse outcomes should consider gender-associated factors in HF patients with frailty.

Prognostic Impact of Heart Failure History in Patients with Secondary Mitral Regurgitation Treated by MitraClip

The aim of this study was to investigate the prognostic role of heart failure (HF) history in patients with secondary mitral regurgitation (SMR) underwent MitraClip. We retrospectively analyzed 186 patients with SMR undergoing MitraClip at 4 centres. HF history was defined as number or days of HF hospitalizations in the 12-month before MitraClip, or as time from last HF hospitalization to MitraClip, or time between first SMR diagnosis and MitraClip. More severe symptoms were observed in patients with >1 HF hospitalization compared with those with ≤1 HF hospitalizations, in those with ≥10 days versus <10 days of HF hospitalization and in those with shortest time from the last HF hospitalization. No significant differences were observed for procedural data in the population stratified according to the different definitions. In variables related with HF history, only the number of HF hospitalizations before MitraClip was associated with an increased risk of clinical events (hazard ratio 1.59; 95% confidence interval [1.09 to 2.12]; p = 0.015), whereas days of previous HF hospitalization, time from last HF hospitalization and from first diagnosis of SMR do not impact on prognosis. A significant decrease in the number and days of HF hospitalizations was observed in the 12-month after MitraClip compared with the 12-month before. In conclusion, in variables related with HF history, recurrence (>1) of HF hospitalizations before MitraClip was the most powerful predictor of prognosis. Latency of intervention did not affect outcomes.

Evaluation of the French National Program on Home Return of Patients with Chronic Heart Failure (PRADO-IC): Pilot Study of 91 Patients During Its Deployment in the Bas Rhin Area.

Objective: The main objective of this study was to evaluate the impact of the French national program on home return of chronic heart failure patients (PRADO-IC) in terms of re-hospitalizations for heart failure (HF) during its deployment in the Bas-Rhin (France). Patients and methods: This was a pilot, descriptive, quantitative, retrospective, and bi-centric study (University Hospitals of Strasbourg and Haguenau Hospital Center, France). It included all patients included in the PRADO-IC program from these centers between January 1, 2015 and December 31, 2015. The primary endpoint of our study was the evaluation of the number of 1-year, 6-month, and 30-day re-admissions to the hospital in relation to an acute HF episode, before and after the inclusion of patients in the PRADO-IC program. The secondary endpoints were the number of overall re-hospitalizations (all-cause); the number of days of hospitalization for HF; the time to first re-hospitalization and the average length of hospital stay, before and after inclusion in PRADO-IC; and the overall and cardiovascular mortality rates. Results: 91 patients out of 271 (33,6%) with a mean age of 79.2 years (67–94) were included. They all had chronic HF, essentially class II-III NYHA (90.1%), mostly of ischemic origin (41.9%), with altered left ventricular ejection fraction in 71.4% of cases. A reduction in the mean number of hospitalizations for HF per patient at 30 days, 6 months and 1 year was observed, respectively, from 0.18 ± 0.42 per patient before inclusion to 0.15 ± 0.36 after inclusion (p = 0.56); 0.98 ± 1.04 hospitalizations to 0.53 ± 0.81 at 6 months (p < 0.01); and 1.64 ± 1.14 hospitalizations 1.04 ± 1.05 at 1 year (p < 0.001). Patients were hospitalized less overall after inclusion in the PRADO-IC program. The number of days of hospitalization for HF was reduced after inclusion of patients from 18.02 ± 7.78 days before inclusion to 14.28 ± 11.57 days for the 6 month follow-up (p = 0.006), and from 22.07 ± 10.33 days before inclusion to 16.39 ± 15.94 days for the 1 year follow-up (p < 0.001). In contrast, inclusion in PRADO-IC statistically increased the mean time to first re-hospitalization for HF from mean 99.36 ± 72.39 days before inclusion to 148.11 ± 112.77 days after inclusion (p < 0.001). Conclusion: This study seems to demonstrate that the PRADO-IC program could improve the management of chronic HF patients in ambulatory care, particularly regarding HF re-hospitalization. However, due to the limitations of the methodology used and the small number of patients, it is advisable to consolidate its initial results with a randomized controlled study on a larger number of patients. In our opinion, its results need to be communicated because, to our knowledge, no equivalent study exists.

Use of Potentially Harmful Drugs among Medicare Beneficiaries with Heart Failure and Reduced Ejection Fraction: Impact on Readmissions and Mortality

Background Multiple cardiac and non-cardiac drugs have the potential to exacerbate heart failure (HF). Information regarding prevalence of their use among elderly patients with HF is scarce. Objectives This study sought to analyze the prevalence and clinical impact of potentially harmful drugs prescriptions as defined in current HF guidelines among elderly patients discharged after a hospitalization for heart failure and reduced ejection fraction (HFrEF). Methods We utilized Centers for Medicare & Medicaid data files from a nationally representative 5% sample for the years 2014-2016 to identify patients admitted with primary diagnosis of HFrEF. To be included in our analysis, patients had to fill a prescription for angiotensin converting enzyme inhibitor, angiotensin receptor blocker or angiotensin receptor-Neprylisin inhibitor and a beta-blocker after discharge. Patients were subsequently divided according to the presence or absence of a prescription for a potentially harmful drug. Results A total of 9,941 patients were included in the study. Potentially harmful drugs were prescribed in 1208 (12.1%) patients within 90 days of HF hospitalization. Non-steroidal anti-inflammatory agents were the most frequently prescribed potentially harmful drugs (6.76%) followed by calcium channel blockers (4.9%), thiazolidinedione (0.66%) and antiarrhythmics (0.35%). Factors associated with potentially harmful drug prescription included female gender, Hispanic ethnicity, severe obesity, hypertension, atrial fibrillation and chronic lung disease. In multivariable analysis the prescription of a potentially harmful drug was significantly associated with increased hospital readmissions (odds ratio 1.14; 95% Confidence Intervals 1.06, 1.22).There was no evidence of increased risk of mortality. Conclusion Approximately 1 in 10 patients admitted with a primary diagnosis of Heart Failure with Reduced Ejection Fraction is prescribed a potentially harmful drug within 90 days of discharge and this is associated with increased risk of hospital readmission.

Serial sodium values and adverse outcomes in heart failure with preserved ejection fraction

ObjectiveThe purpose of our study is to examine whether serial measurements of serum sodium values after diagnosis identify a higher-risk subset of patients with heart failure with preserved ejection fraction. MethodsWe identified 50,932 subjects with HFpEF with 759,577 recorded sNa measurements (mean age 72 ± 11 years) using a validated algorithm in the VA national database from 2002 to 2012. We examined the association of repeated measures of sNa with mortality using a multivariable Cox proportional hazards model. ResultsAfter a median follow-up of 2.9 years (IQR: 1.2–5.4), 19,011 deaths occurred. After adjusting for age, sex, race, BMI, glomerular filtration rate, potassium, coronary artery disease, hypertension, hyperlipidemia, atrial fibrillation, pulmonary disease, diabetes, anemia, and medications, we found J-shaped associations of serum sodium with mortality. HRs for all-cause mortality were 2.48 (95% CI: 2.38–2.60) for the sNA 115.00–133.99 category; and 1.40 (95% CI: 1.35–1.46) for the sNA 143.00–175.00 category compared to the 137.01–140.99 category (ref). We used generalized estimating equation-based negative binomial regression to compute the incidence density ratios (IDR) to examine days hospitalized for heart failure and for all causes. There were a total of 1,275,614 days of all-cause hospitalization and 104,006 days of heart-failure hospitalization. The IDRs for the lowest sNA group were 2.03 (95% CI: 1.90–2.18) for all-cause hospitalization and 1.73 (95% CI: 1.39–2.16) for heart-failure hospitalization. ConclusionsOur findings suggest that monitoring of serum sodium values during longitudinal follow-up can identify HFpEF patients at risk of adverse outcomes.

Abstract 197: Root Cause Analysis of 30-day Heart Failure Readmission Elucidates Acute Kidney Injury as a Common Offender

Background: Hospitalization for heart failure (HF) and heart transplant is associated with a high likelihood of readmission within 30 days of discharge. Our study objective was to identify risk factors and causes for readmission at a high acuity tertiary academic medical center in order to develop targeted interventions aimed at HF readmission reduction. Methods: We retrospectively reviewed 49 sequential cases of patients readmitted within 30 days of hospitalization for HF (41) or heart transplant (8) between Q3-Q4 2014. Two unblinded reviewers determined the root causes of readmission, likelihood of readmission prevention, and interventions most likely to prevent similar readmissions from recurring. Results: HF exacerbation was the primary reason for readmission in 47% (23/49) of cases. Also in 47% (23/49) of the readmissions, the possibility for preventing the readmission had an appropriate intervention been implemented was determined to be at least 50%. The other 53% (26/49) of readmissions were considered unlikely to have been readily preventable. Medical complications were the primary cause of readmission in 14% (7/49) of cases, of which acute kidney injury (AKI) was the most common. Over one-fourth (13/49) of all readmissions were found to have at least a 15% increase in creatinine level from time of discharge to time of readmission. Dietary indiscretion (8% i.e. 4/49), psychosocial factors (8%), and progression of disease (8%) were other notable root causes for readmission. When assessing the most likely part of patient care to address to prevent readmission, more proactive follow-up/monitoring was considered to be the most high-yield intervention in 14% of cases i.e. 7/49. Also of note, reclassifying admissions as observation status based on length of stay would have prevented 33% (16/49) of cases from meeting readmission criteria. Conclusion: Our study supports a multifaceted, multidisciplinary approach to reducing HF readmissions, given the array of readmission causes and targeted areas for intervention identified. It also demonstrates that AKI may be an underappreciated cause for readmission, with 28% of all-cause readmissions presenting with creatinine elevations of at least 15%. Therefore, in addition to a multidisciplinary approach to discharge planning, we recommend institutions implement specific strategies to reduce AKI.

Abstract 18473: Filling a β-blocker in the Week After Discharge for a Heart Failure Hospitalization is Associated With a Lower Risk of Rehospitalization Among Medicare Beneficiaries

Introduction: In clinical trial populations with heart failure (HF) and reduced ejection fraction, there is evidence that the β-blockers metoprolol succinate, carvedilol, and bisoprolol reduce mortality and hospitalizations. The short-term impact of β-blockers among typical hospitalized HF patients with heavy comorbidity burdens is less clear. Hypothesis: Filling a β-blocker within 7 days of HF hospitalization is associated with lower rehospitalization risk 8-30 days after discharge. Methods: We identified 76,568 HF hospitalizations in the Medicare national 5% sample among beneficiaries with fee-for-service and medication coverage (20,358 with documented systolic dysfunction). Beneficiary characteristics, β-blocker fills, and rehospitalization for HF, cardiovascular disease (CVD), or any cause were assessed through Medicare claims. We used generalized estimating equations to calculate multivariable-adjusted risk ratios for rehospitalization. Results: The average age was 76 years, 61% were women, and 19% were black. Comorbidities were common (hypertension 85%, coronary heart disease 70%, chronic kidney disease 65%, chronic obstructive pulmonary disease 57%, diabetes 53%, atrial fibrillation 48%, depression 25%, hypotension 21%, valvular or rheumatic heart disease 15%). Almost all had prior diagnoses of HF (99%). Within 7 days of discharge, 25% filled any β-blocker and 17% filled metoprolol succinate, carvedilol, or bisoprolol. In the 8-30 days following discharge, 9% were rehospitalized for HF, 12% for CVD, and 22% for any cause. Filling a β-blocker was associated with a lower risk rehospitalization for HF, CVD, and any cause in both the overall population and the subgroup with documented systolic dysfunction ( Table ). Conclusions: Medicare beneficiaries with HF who filled β-blockers shortly after discharge had better short-term prognosis; however, risk of rehospitalization among those with and without β-blocker fills was high.

N-Terminal Pro–B-Type Natriuretic Peptide–Guided, Intensive Patient Management in Addition to Multidisciplinary Care in Chronic Heart Failure: A 3-Arm, Prospective, Randomized Pilot Study

This study was designed to investigate whether the addition of N-terminal pro-B-type natriuretic peptide-guided, intensive patient management (BM) to multidisciplinary care (MC) improves outcome in patients following hospitalization due to heart failure (HF).Patients hospitalized due to HF experience frequent rehospitalizations and high mortality.Patients hospitalized due to HF were randomized to BM, MC, or usual care (UC). Multidisciplinary care included 2 consultations from an HF specialist who provided therapeutic recommendations and home care by a specialized HF nurse. In addition, BM included intensified up-titration of medication by HF specialists in high-risk patients. NT-proBNP was used to define the level of risk and to monitor wall stress. This monitoring allowed for anticipation of cardiac decompensation and adjustment of medication in advance.A total of 278 patients were randomized in 8 Viennese hospitals. After 12 months, the BM group had the highest proportion of antineurohormonal triple-therapy (difference among all groups). Accordingly, BM reduced days of HF hospitalization (488 days) compared with the hospitalization for the MC (1,254 days) and UC (1,588 days) groups (p < 0.0001; significant differences among all groups). Using Kaplan-Meier analysis, the first HF rehospitalization (28%) was lower in the BM versus MC groups (40%; p = 0.06) and the MC versus UC groups (61%; p = 0.01). Moreover, the combined end point of death or HF rehospitalization was lower in the BM (37%) than in the MC group (50%; p < 0.05) and in the MC than in the UC group (65%; p = 0.04). Death rate was similar between the BM (22%) and MC groups (22%), but was lower compared with the UC group (39%; vs. BM: p < 0.02; vs. MC: p < 0.02).Compared with MC alone, additional BM improves clinical outcome in patients after HF hospitalization. (BNP Guided Care in Addition to Multidisciplinary Care; NCT00355017).

The effects of eplerenone on length of stay and total days of heart failure hospitalization after myocardial infarction in patients with left ventricular systolic dysfunction

Heart failure (HF) with reduced left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI) is associated with increased readmission rates. This study evaluated the effects of eplerenone, a selective aldosterone blocking agent, on the duration of subsequent hospitalizations for HF in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). The EPHESUS study included 6,632 patients post-AMI with LVEF < or =40% and clinical HF or diabetes, receiving standard therapy, randomized to either eplerenone 25 mg, titrated to 50 mg daily, or placebo, with a mean follow-up of 16 months. Analyses of the length of stay and total number of days of HF hospitalizations per patient were conducted on a subgroup of 828 patients with subsequent HF hospitalizations, overall and across 5 distinct geographic regions. Eplerenone was associated with a 1.6-day reduction in the mean length of HF hospitalization (9.2 vs 10.8 days with placebo; P = .019) and 3.6-day reduction in the total days spent in the hospital for HF (13.3 vs 16.9 days with placebo; P = .0006). These benefits were observed in all geographic regions. In patients post-AMI with reduced LVEF and HF or diabetes, eplerenone added to standard therapy reduced the mean length and total days of HF hospitalizations compared to placebo in all regions. Given the high cost of hospital care for HF, these findings may translate into an economic benefit to health care worldwide.