Two-­year prognosis of patients hospitalized for decompensated heart failure in a district general hospital

Abstract

Background Patients hospitalized for heart failure (HF) exacerbation tend to have a poor prognosis. Most previous studies were performed in large clinical centers and detailed analyses of patients with HF hospitalized in district general hospitals are lacking. aims The aim of this study was to assess the outcomes of patients admitted with HF exacerbation to a district general hospital. methods We retrospectively enrolled patients hospitalized for HF exacerbation in the years 2010 to 2011 (191 patients) and 2016 to 2017 (203 patients). The primary and secondary endpoints were all -cause mortality and rehospitalization due to HF exacerbation, respectively, within a 2-year follow -up. results Compared with patients hospitalized from 2010 to 2011, those hospitalized from 2016 to 2017 had more favorable clinical parameters and more appropriate pharmacological treatment; however, the rate of implantable cardioverter -defibrillator and resynchronization device use remained low. The overall mortality decreased from 44% between 2010 and 2011 to 33% between 2016 and 2017 (P = 0.03), but the number of rehospitalizations increased from 26% to 41%, respectively (P <0.001). Male sex, low systolic blood pressure, symptoms of right HF, and renal dysfunction were independent risk factors for the primary endpoint. Symptoms of right HF, renal dysfunction, left ventricular ejection fraction below 24%, and low systolic blood pressure independently predicted the secondary endpoint. conclusions The prognosis of patients hospitalized for decompensated HF in a regional district hospital was poor. Despite some improvement in pharmacological treatment, which probably led to reduced all--cause mortality, there was a low rate of implantable electronic device use and a high rate of rehospitalizations due to HF exacerbation, which needs further elucidation.

Atrial fibrillation and elevated heart rate: Independent prognostic factors of right ventricular dysfunction in patients with heart failure with reduced ejection fraction

“…RV failure has been repeatedly shown to compromise the prognosis in heart failure. In a recent study, it was confirmed to be an independent prognostic factor of all-cause mortality and rehospitalization for heart failure [6]. It underlines the need for the search for therapies focused on preserving RV function in heart failure.…”

Risk factors for poor prognosis in heart failure with particular attention to the elderly population

“…It should be noted that the percentage of patients enrolled in the study with implantable cardioverter-defibrillators (including cardiac resynchronization therapy) is disproportionately small concerning the number of patients with LVEF < 40 % and even lower in the elderly patients (Table 4). We precisely analyzed and discussed this problem in our previous study [15]. It also seems interesting that the subgroup with the composite end-points, was characterized by a higher rate of implanted ICD/CRT.…”

“…This study is a sub-analysis of our retrospective project [15] of all patients hospitalized with a diagnosis of acutely decompensated chronic HF and new-onset acute HF [16] in at a single cardiology department (St. Vincent Hospital in Gdynia, Poland) during 2016-2017. Further analysis included: the patient's biometric parameters, the medical history available in the documentation (with particular emphasis on comorbidities, condition of the coronary vessels, implanted devices, the treatment so far), physical examination findings documented during hospitalization, laboratory results, electrocardiography and echocardiography [15]. The data was obtained from the hospital's medical records and electronic patient records.…”

Wavelet transform analysis reveals differences between patients with impaired left ventricular systolic function and healthy individuals

“…Despite continuous progress in both pharmacological therapy and invasive methods (McDonagh et al 2021) (McDonagh et al 2021; Ahmed et al 2021; Hussein et al 2019), all-cause mortality in HF patients remains high with substantial economic burden on healthcare systems (Spencer et al 2018; Savarese et al 2022). HF is the leading cause of hospitalizations, resulting in more than 1 million admissions in both the United States and Europe (Blecker et al 2013; Dobrowolska et al 2021).…”