Repeated Hospitalizations Predict Mortality in Heart Failure
Repeated Hospitalizations Predict Mortality in Heart Failure
Background: Identification of patients at high risk of death is critical for appropriate management of patients and health care resources. The impact of repeated heart failure (HF) hospitalization on mortality has not been studied for a large community population with HF. We aimed to characterize survival of patients in relation to the number of HF hospitalizations.
Method: Using the health care utilization databases, we identified a cohort of patients with a first hospitalization for HF among all residents of British Columbia between 2000 and 2004. Survival time was measured after patients' first and each subsequent HF hospitalization. Kaplan-Meier cumulative mortality curves were constructed after each subsequent HF hospitalization. Hazard ratios for the number of HF hospitalizations were estimated using a multivariate Cox regression adjusting for major comorbidities.
Results: Of 14374 patients hospitalized for HF, 7401 died during the 24766 person-years of follow-up. Mortality significantly increased after each HF hospitalization. After adjusting for age, sex, and major comorbidities, the number of HF hospitalizations was a strong predictor of all-cause death. Median survival after the first, second, third, and fourth hospitalization was 2.4, 1.4, 1.0, and 0.6 years. Advanced age, renal disease, and history of cardiac arrest attenuated the impact of the number of HF hospitalizations.
Conclusions: The number of HF hospitalizations is a strong predictor of mortality in community HF patients. This simple predictor of mortality in HF patients should help triage management and resources for HF and trigger patient planning for prognosis.
The prevalence and economic burden of heart failure (HF) have been increasing during the past several decades, with an estimated 5 million people currently diagnosed. The number of hospitalizations with HF as the first listed diagnosis has increased steadily over the last 3 decades, with 1093000 hospitalizations for HF in 2003. Heart failure is also the leading cause of hospital readmission within 60 days of discharge.
Heart failure is the end stage of cardiac disease, with 1-year mortality rate of 30% to 50% described previously after the first hospitalization has occurred. Although new management options, including costly medications, implantable cardioverter-defibrillators, left ventricular assist devices, and transplantation, have improved survival and quality of life for selected patients with HF, health care systems face difficult decisions regarding the allocation of these and other limited resources within the broader community. Health care staffs need guidance to time discussions with individual patients and families about prognosis and plans for the end of life.
Most studies examining predictors of survival in HF describe single-center experiences or trial populations with many exclusions that limit enrollment of older patients with HF. A recent study suggested that one previous HF hospitalization is a predictor of death. However, in the community population, the first HF hospitalization is often the time of first HF diagnosis, after which evaluation and treatment are initiated. The mortality of patients with HF in relation to the number of additional HF hospitalizations has not been studied in a community population. The aim of the current study is to characterize the mortality of HF patients with repeated hospitalizations.
Abstract and Introduction
Abstract
Background: Identification of patients at high risk of death is critical for appropriate management of patients and health care resources. The impact of repeated heart failure (HF) hospitalization on mortality has not been studied for a large community population with HF. We aimed to characterize survival of patients in relation to the number of HF hospitalizations.
Method: Using the health care utilization databases, we identified a cohort of patients with a first hospitalization for HF among all residents of British Columbia between 2000 and 2004. Survival time was measured after patients' first and each subsequent HF hospitalization. Kaplan-Meier cumulative mortality curves were constructed after each subsequent HF hospitalization. Hazard ratios for the number of HF hospitalizations were estimated using a multivariate Cox regression adjusting for major comorbidities.
Results: Of 14374 patients hospitalized for HF, 7401 died during the 24766 person-years of follow-up. Mortality significantly increased after each HF hospitalization. After adjusting for age, sex, and major comorbidities, the number of HF hospitalizations was a strong predictor of all-cause death. Median survival after the first, second, third, and fourth hospitalization was 2.4, 1.4, 1.0, and 0.6 years. Advanced age, renal disease, and history of cardiac arrest attenuated the impact of the number of HF hospitalizations.
Conclusions: The number of HF hospitalizations is a strong predictor of mortality in community HF patients. This simple predictor of mortality in HF patients should help triage management and resources for HF and trigger patient planning for prognosis.
Introduction
The prevalence and economic burden of heart failure (HF) have been increasing during the past several decades, with an estimated 5 million people currently diagnosed. The number of hospitalizations with HF as the first listed diagnosis has increased steadily over the last 3 decades, with 1093000 hospitalizations for HF in 2003. Heart failure is also the leading cause of hospital readmission within 60 days of discharge.
Heart failure is the end stage of cardiac disease, with 1-year mortality rate of 30% to 50% described previously after the first hospitalization has occurred. Although new management options, including costly medications, implantable cardioverter-defibrillators, left ventricular assist devices, and transplantation, have improved survival and quality of life for selected patients with HF, health care systems face difficult decisions regarding the allocation of these and other limited resources within the broader community. Health care staffs need guidance to time discussions with individual patients and families about prognosis and plans for the end of life.
Most studies examining predictors of survival in HF describe single-center experiences or trial populations with many exclusions that limit enrollment of older patients with HF. A recent study suggested that one previous HF hospitalization is a predictor of death. However, in the community population, the first HF hospitalization is often the time of first HF diagnosis, after which evaluation and treatment are initiated. The mortality of patients with HF in relation to the number of additional HF hospitalizations has not been studied in a community population. The aim of the current study is to characterize the mortality of HF patients with repeated hospitalizations.