Clinical features, and in-hospital and 1-year mortalities of patients with acute heart failure and severe renal dysfunction. Data from the Italian Registry IN-HF Outcome

Cioffi, Giovanni; Mortara, Andrea; Lenarda, Andrea Di; Oliva, Fabrizio; Lucci, Donata; Senni, Michele; Cacciatore, Giuseppe; Chinaglia, Alessandra; Tarantini, Luigi; Metra, Marco; Maggioni, Aldo P.; Tavazzi, Luigi

doi:10.1016/j.ijcard.2013.06.020

Cited by 21 publications

(10 citation statements)

References 37 publications

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“…The predictors of all‐cause mortality among AHF patients in this study were similar to those found in previous studies, in which older age, lower blood pressure, hepatic or renal dysfunction, previous stroke, diabetes, COPD, aortic stenosis, lower EF, and pulmonary or peripheral congestion were all predictive of an adverse outcome . These observations reinforce recommendations that patients only be discharged when signs of congestion have completely resolved.…”

Section: Discussionsupporting

confidence: 89%

“…The cost of HF health care is high and increasing and there has been an increase in CHF‐related hospitalizations, reaching more than 1 million per year in both the USA and Europe . In pursuit of optimal care, the management of HF patients should be guided by protocols that clinical trial evidence has shown to be beneficial . Registries can help improve care by both contributing evidence and monitoring compliance with existing guidelines.…”

Section: Introductionmentioning

confidence: 99%

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European Society of Cardiology Heart Failure Long‐Term Registry (ESC‐HF‐LT): 1‐year follow‐up outcomes and differences across regions

Crespo-Leiro

Anker

Maggioni

et al. 2016

European J of Heart Fail

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638

466

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

European Society of Cardiology Heart Failure Long‐Term Registry (ESC‐HF‐LT): 1‐year follow‐up outcomes and differences across regions

Crespo-Leiro

Anker

Maggioni

et al. 2016

European J of Heart Fail

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638

466

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“…The high prevalence and crucial role of renal dysfunction on short and long‐term prognosis are well known: it complicates drug management and is associated with diuretic resistance and lower RAS‐inhibitors prescription. We observed, with decreasing GFR at discharge, increasing LOS and diuretic doses, both in hospital and at discharge, and a large gap in RAS‐inhibitor use.…”

Section: Discussionmentioning

confidence: 99%

The 30‐day metric in acute heart failure revisited: data from IN‐HF Outcome, an Italian nationwide cardiology registry

Tano

Maria

Gonzini

et al. 2015

European J of Heart Fail

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Aims Unplanned readmissions early after a discharge from acute heart failure hospitalization are common and have become a reimbursement benchmark and marker of hospital quality. However, the competing risk of short‐term post‐discharge mortality is substantial. Methods and results Using data from the prospective, nationwide Registry IN‐HF Outcome, we analysed the incidence and predictors of 30‐day mortality or readmissions and associated days‐alive‐out‐of‐hospital (DAOH) in 1520 patients discharged alive after admission for acute heart failure. Within 30 days after discharge, 94 patients (6.2%) were readmitted (91% for cardiovascular causes; 60% recurrent heart failure) and 42 (2.8%) died, 10 of which occurred during readmission. Overall, 126 patients (8.3%) met the combined endpoint. By multivariable logistic regression, worsening chronic heart failure as clinical presentation [odds ratio (OR) 1.83, 95% confidence interval (CI) 1.21–2.77, P = 0.005), inotropes during admission (OR 2.19, 95% CI 1.40–3.43, P = 0.0006), length of stay (OR 1.02, 95% CI 1.01–1.04, P = 0.002) and renin–angiotensin system inhibitors at discharge (OR 0.52, 95%CI 0.35–0.77, P = 0.001) independently predicted 30‐day all‐cause mortality and/or readmission (c‐statistic = 0.695). Per cent 30‐day DAOH was lower in patients with in‐hospital inotrope use, no renin–angiotensin system inhibitors prescription at discharge, New York Heart Association III–IV class at discharge, and correlated inversely with length of stay and age. Conclusion A clinical and biohumoral profile consistent with chronic advanced heart failure and end‐organ damage identifies acute heart failure patients discharged home from cardiology units, who are at highest risk of early death and/or readmission. These findings have practical implications for tailoring specific follow‐up.

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“…Firstly, the calculation of the GFR was originally developed for use in patients with chronic kidney disease whose renal functions are relatively stable; the applicability of this calculation for patients with ADHF has not been sufficiently validated. However, previous studies have demonstrated an association between reduced GFRs and adverse outcomes in patients with ADHF [24]–[26]. Our intent was to estimate the level of renal dysfunction in our study population, rather than to determine the precise renal function levels of these patients.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Renal Dysfunction Does Not Differ According to the Clinical Profiles of Patients: Insight from the Acute Decompensated Heart Failure Syndromes (ATTEND) Registry

et al. 2014

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BackgroundRenal dysfunction associated with acute decompensated heart failure (ADHF) is associated with impaired outcomes. Its mechanism is attributed to renal arterial hypoperfusion or venous congestion, but its prognostic impact based on each of these clinical profiles requires elucidation.Methods and ResultsADHF syndromes registry subjects were evaluated (N = 4,321). Logistic regression modeling calculated adjusted odds ratios (OR) for in-hospital mortality for patients with and without renal dysfunction. Renal dysfunction risk was calculated for subgroups with hypoperfusion-dominant (eg. cold extremities, a low mean blood pressure or a low proportional pulse pressure) or congestion-dominant clinical profiles (eg. peripheral edema, jugular venous distension, or elevated brain natriuretic peptide) to evaluate renal dysfunction's prognostic impact in the context of the two underlying mechanisms. On admission, 2,150 (49.8%) patients aged 73.3±13.6 years had renal dysfunction. Compared with patients without renal dysfunction, those with renal dysfunction were older and had dominant ischemic etiology jugular venous distension, more frequent cold extremities, and higher brain natriuretic peptide levels. Renal dysfunction was associated with in-hospital mortality (OR 2.36; 95% confidence interval 1.75–3.18, p<0.001), and the prognostic impact of renal dysfunction was similar in subgroup of patients with hypoperfusion- or congestion-dominant clinical profiles (p-value for the interaction ranged from 0.104–0.924, and was always >0.05).ConclusionsBaseline renal dysfunction was significantly associated with in-hospital mortality in ADHF patients. The prognostic impact of renal dysfunction was the same, regardless of its underlying etiologic mechanism.

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Clinical features, and in-hospital and 1-year mortalities of patients with acute heart failure and severe renal dysfunction. Data from the Italian Registry IN-HF Outcome

Cited by 21 publications

References 37 publications

European Society of Cardiology Heart Failure Long‐Term Registry (ESC‐HF‐LT): 1‐year follow‐up outcomes and differences across regions

European Society of Cardiology Heart Failure Long‐Term Registry (ESC‐HF‐LT): 1‐year follow‐up outcomes and differences across regions

The 30‐day metric in acute heart failure revisited: data from IN‐HF Outcome, an Italian nationwide cardiology registry

Prognostic Impact of Renal Dysfunction Does Not Differ According to the Clinical Profiles of Patients: Insight from the Acute Decompensated Heart Failure Syndromes (ATTEND) Registry

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