Characteristics and Outcomes of Patients With Acute Decompensated Heart Failure Developing After Hospital Admission

Abstract

There are limited data on ADHF that develops after hospital admission. This study sought to compare patient characteristics, comorbidities, mortality, and length of stay by timing of acute decompensated heart failure (ADHF) onset. The surveillance component of the Atherosclerosis Risk in Communities Study (2005–2011) sampled, abstracted, and adjudicated hospitalizations with select ICD-9-CM discharge codes from 4 U.S. communities among those aged 55 years and older. We included 5,602 validated ADHF hospitalizations further classified as pre- or post-admission onset. Vital status was assessed up to 1 year since admission. We estimated multivariable-adjusted associations of in-hospital mortality, 28-day case fatality, and 365-day case fatality with timing of ADHF onset (post-versus pre-admission). All analyses were weighted to account for the stratified sampling design. Of 25,862 weighted ADHF hospitalizations, 7% had post-admission onset of ADHF. Patients with post-admission ADHF were more likely to be older, white, and female. The most common primary discharge diagnosis codes for those with post-admission ADHF included diseases of the circulatory or digestive systems or infectious diseases. Short-term mortality among post-admission ADHF was almost 3 times that of pre-admission ADHF (in-hospital mortality: odds ratio: 2.7, 95% confidence interval: 1.9–3.9; 28-day case fatality: odds ratio: 2.6, 95% confidence interval: 1.8–3.7). The average hospital stay was almost twice as long among post-admission as pre-admission ADHF (9.6 vs. 5.0 days). In conclusion, post-admission onset of ADHF is characterized by differences in comorbidities and worse short-term prognosis, and opportunities for reducing post-admission ADHF occurrence and associated risks need to be studied.

Effect of targeted fluid minimization and diuretic therapy on hospital- acquired heart failure and adverse outcomes in patients with no preexisting cardiac dysfunction

“…1,2,4−6 Patel et al demonstrated that short-term mortality in hospital-acquired HF was 3 times the rate of preadmission HF. 4 Patients with hospital-acquired HF had a worse short-term prognosis compared with those with preadmission HF. The authors reported in-hospital mortality of 16%.…”

“…Patel et al reported that 7% of acute HF hospitalizations in patients with the age over 55 had post-admission onset of acute HF or hospitalacquired HF. 4 However, they did not examine the association between uid volume and hospital-acquired HF. Branan et al studied the hidden uid administration, including IV medication, line ushes, blood products, and enteral nutrition, and the development of uid overload, de ned as a positive accumulative uid balance producing weight gain over 10% from baseline, in 219 ICU patients.…”

“…These higher rates of subsequent ICU transfer and mechanical ventilator usage is in concordance with results from previous studies. 4,5 Intervention Protocol Previous studies have shown that IV uid volume is associated with hospital-acquired HF, uid overload, and adverse outcomes [1][2][3][4][5][6] . Plant et al found that failure to restart regular diuresis was common in the hospital-acquired HF group.…”

“…Acute de novo heart failure (HF) developing after hospital admission or hospital-acquired heart failure (HF) is associated with a greater length of hospital stay and mortality. [1][2][3][4][5][6] The mortality of patients with hospital-acquired HF has been shown to be approximately 3 times the rate preadmission HF or general acute decompensated HF. 4 Previous studies have shown that inappropriate intravenous (IV) uid and failure to restart regular diuretics were related to hospital-acquired HF.…”

Recruitment and Retention Challenges of Examining Cognitive Dysfunction in Older Adults Hospitalized for Acute Heart Failure

“…One was that the mean length of stay for patients with acute heart failure is between 5 and 6 days. 12,13 This length of stay contributed to a narrow recruitment and retention window, once patients' conditions were hemodynamically stable. Another factor was the presence of symptoms of acute heart failure and a high number of nonspecific reasons for refusal.…”