Incidence and Predictors of Rehospitalization of Acute Heart Failure Patients

Abstract

SummaryRepeated hospitalization due to acute decompensated heart failure (HF) is a pandemic health problem in Japan. However, it is difficult to predict rehospitalization after discharge for acute decompensated HF. We used a single hospital-based cohort from the Shinken Database 2004Database -2012 who visited the Cardiovascular Institute Hospital. A total of 282 patients discharged after their first acute HF admission were included in the analysis. The median follow-up period was 908 ± 865 days. Of these patients, rehospitalization due to worsening HF occurred in 55 patients. The cumulative rate of rehospitalization was 17.5% at 1 year, 21.4% at 2 years, and 25.5% at 3 years. Patients with rehospitalization were older than those without rehospitalization. Prevalence of diabetes mellitus (DM) was more common in patients with rehospitalization. Average heart rate (HR) tended to be higher in patients with rehospitalization. Loop diuretics were more commonly used at hospital discharge in patients with rehospitalization. Multivariate Cox regression analysis revealed that age ≥ 75 years, DM, HR ≥ 75 bpm at discharge, and use of loop diuretics at discharge were independent predictors for rehospitalization. The number of these independent risk factors could be used to clearly discriminate between the HF rehospitalization low-, middle-and high-risk patients. HF rehospitalization commonly occurred in patients who were discharged after their first acute HF admission. Older age, DM, increased HR, and loop diuretics use at discharge were independently associated with HF rehospitalization. By simply counting these risk factors, we might be able to predict the risk of HF rehospitalization after discharge. (Int Heart J 2015; 56: 219-225)

Predictive factors of rehospitalization for worsening heart failure and cardiac death within 1 year in octogenarians hospitalized for heart failure

“…Also, non‐cardiac comorbidities, such as hypertension, renal disease, chronic obstructive pulmonary diseases, cognitive and depressive disorders, and diabetes mellitus, are known to be associated with worse clinical outcome in older patients . In older patients, treatment is often complicated by multiple comorbidities, and it is difficult to carry out evidence‐based therapies in older patients . In the present study, the prevalence of rehospitalization for worsening HF or cardiac death within 1 year after hospital discharge was 41.8% in older patients hospitalized for HF.…”

“…2 The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) study showed that the patients aged >80 years who were hospitalized for HF had a worse prognosis than that for younger patients. 3,4 Repeated rehospitalization of older patients is a major problem in the healthcare system, and improvement of the clinical management of HF in older patients is an important issue. However, older patients have been excluded in most large-scale clinical trials.…”

Role of Right Ventricular Dysfunction and Diabetes Mellitus in N-terminal pro-B-type Natriuretic Peptide Response of Patients With Severe Mitral Regurgitation and Heart Failure After MitraClip

“…[29][30][31] We previously reported that rehospitalization of acute HF patients was more common in patients with DM. 32) In this context, the presence of DM may inhibit the improvement of HF, resulting in the persistent elevation of the plasma NT-pro BNP level. Hellhammer, et al reported that the MC procedure is safe and effective in patients with DM.…”

Rehospitalisation rates and associated factors within 6 months after hospital discharge for patients with chronic heart failure: A longitudinal observational study

“…A study by Smith, Denollet, Schiffer, Kupper, and Gidron () showed that the readmission rate was 30.2% within 12 months of release in the Netherlands. Kaneko et al () found the cumulative rates of hospital readmission were 17.5% at 1 year, 21.4% at 2 years and 25.5% at 3 years among Japanese acute HF patients. Similar studies were also conducted among Chinese HF patients.…”