The Impact of Early Readmission on Subsequent Long-term Clinical Outcomes in Patients Hospitalized for Acute Heart Failure

Abstract Background Regardless of diabetes mellitus (DM), admission hyperglycemia is not uncommon in patients with acute heart failure (AHF). Although DM is a well-known predictor of mortality in AHF, the impacts of admission hyperglycemia on clinical outcomes in non-DM patients with AHF have been poorly studied. The aim of this study, therefore, was to compare the impact of admission hyperglycemia on long-term clinical outcomes in AHF patients with or without DM. Methods Among 5,625 AHF patients enrolled in a nationwide registry, a total of 5,541 patients were enrolled and divided into 2 groups; DM group (n=2,125, 70.4±11.4 years) vs. non-DM group (n=3,416, 67.3±16.0 years). Each group were further divided into 2 groups according to the presence of admission hyperglycemia (admission serum glucose level >200mg/dl); admission hyperglycemia (n=248) and no hyperglycemia (n=3,168) in non-DM; admission hyperglycemia (n=799) and no hyperglycemia (n=1,326) in DM. All-cause death and hospitalization due to HF (HHF) during 1-year follow-up were compared. Results Death was developed in 1,220 patients (22.2%) including 269 inhospital deaths (4.9%) during 1-year of follow-up. Death rate were significantly higher in DM than in non-DM group (24.8% vs 20.5%, p<0.001), however there was no difference in inhospital death (5.1% vs 4.7%, p=0.534). Both inhospital death (7.6% vs. 4.2%, p<0.001) and 1-year death (26.2% vs. 21.3%, p=0.001) were more frequent in AHF patients with hyperglycemia. On Kaplan-Meier survival curve analysis, however, admission hyperglycemia was associated with significantly higher death (p<0.001 by log-rank test) and rehospitalization (p=0.006 by log-rank test) in non-DM group, but not in DM group. In non-DM group, admission hyperglycemia was an independent predictor of 1-year mortality (HR 1.46, 95% CI 1.10–1.93, p=0.009). Conclusion DM was a significant predictor of long-term mortality in patients with AHF. Admission hyperglycemia was associated with both higher inhospital and 1-year mortality. The present study also demonstrated that admission hyperglycemia is an independent predictor of mortality in non-DM patients with AHF, but not in DM patients. In addition to the presence of DM, admission hyperglycemia would be a useful marker in the risk stratification of AHF, especially in non-DM patients.

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Sex Differences in Long-Term Clinical Outcomes in Patients Hospitalized for Acute Heart Failure: A Report from the Korean Heart Failure Registry

Journal of Women s Health ◽

10.1089/jwh.2018.7404 ◽

2019 ◽

Vol 28 (12) ◽

pp. 1606-1613

Author(s):

Jaehoon Chung ◽

Hack-Lyoung Kim ◽

Myung-A Kim ◽

Dong-Ju Choi ◽

Seongwoo Han ◽

...

Keyword(s):

Heart Failure ◽

Sex Differences ◽

Clinical Outcomes ◽

Acute Heart Failure

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Evaluation of Thyroid Function in Patients Hospitalized for Acute Heart Failure

International Journal of Endocrinology ◽

10.1155/2021/6616681 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Ana Rita Leite ◽

João Sérgio Neves ◽

Marta Borges-Canha ◽

Catarina Vale ◽

Madalena von Hafe ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Clinical Outcomes ◽

Acute Heart Failure ◽

Thyroid Function ◽

Short Term ◽

Cardiovascular Parameters ◽

Adjusted Model ◽

Long Term Mortality

Background. Thyroid hormones (TH) are crucial for cardiovascular homeostasis. Recent evidence suggests that acute cardiovascular conditions, particularly acute heart failure (AHF), significantly impair the thyroid axis. Our aim was to evaluate the association of thyroid function with cardiovascular parameters and short- and long-term clinical outcomes in AHF patients. Methods. We performed a single-centre retrospective cohort study including patients hospitalized for AHF between January 2012 and December 2017. We used linear, logistic, and Cox proportional hazard regression models to analyse the association of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) with inpatient cardiovascular parameters, in-hospital mortality, short-term adverse clinical outcomes, and long-term mortality. Two models were used: (1) unadjusted, and (2) adjusted for age and sex. Results. Of the 235 patients included, 59% were female, and the mean age was 77.5 (SD 10.4) years. In the adjusted model, diastolic blood pressure was positively associated with TSH [β = 2.68 (0.27 to 5.09); p = 0.030 ]; left ventricle ejection fraction (LVEF) was negatively associated with FT4 [β = -24.85 (-47.87 to -1.82); p = 0.035 ]; and a nonsignificant trend for a positive association was found between 30-day all-cause mortality and FT4 [OR = 3.40 (0.90 to 12.83); p = 0.071 ]. Among euthyroid participants, higher FT4 levels were significantly associated with a higher odds of 30-day all-cause death [OR = 4.40 (1.06 to 18.16); p = 0.041 ]. Neither TSH nor FT4 levels were relevant predictors of long-term mortality in the adjusted model. Conclusions. Thyroid function in AHF patients is associated with blood pressure and LVEF during hospitalization. FT4 might be useful as a biomarker of short-term adverse outcomes in these patients.

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Abstract 14982: Impact of Health Literacy on Long-Term Outcomes in Patients with Heart Failure

Circulation ◽

10.1161/circ.130.suppl_2.14982 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Miyuki Tsuchihashi-Makaya ◽

Shiho Matsuoka ◽

Takahiro Kayane ◽

Masako Koizumi ◽

Michiyo Yamada ◽

...

Keyword(s):

Heart Failure ◽

Depressive Symptoms ◽

Health Literacy ◽

Clinical Outcomes ◽

Cox Regression ◽

Adverse Outcomes ◽

World Health ◽

Risk Of Death ◽

The Impact

Introduction: Health literacy (HL) is an important concept for patient education and disease management of heart failure (HF). It has been demonstrated that HL is associated with clinical outcomes including death and readmission. Although previous research on HL has predominantly focused on functional HL (the ability to “read and write”), the World Health Organization advocates evaluation of comprehensive HL, including the ability to access information (communicative HL) and critically evaluate information (critical HL). However, the impact of these three HL components on long-term adverse outcomes in patients with HF has never been fully investigated. Methods: We conducted a prospective observational study to examine the associations between HL level and risk of death or readmission in 234 patients (mean age, 67.8 years; male, 62%). HL, including subscales of functional, communicative, and critical HL, was assessed using the HF specific HL scale, which has been reported to be valid and reliable in patients with HF. Sociodemographic, clinical, and depressive symptoms were also assessed. Mortality and hospitalization data were obtained during a 2 year follow-up (median duration, 707 days). Results: Among all patients, 19.7% exhibited a low HL score. In each subscale, 19.7%, 23.1%, and 23.9% of patients exhibited low functional, low communicative, and low critical HL, respectively. Patients with low HL were older and living alone. In multivariate Cox regression, low critical HL was independently associated with higher readmission exacerbated HF after controlling for demographic and clinical characteristics, HF severity, depressive symptoms at baseline (unadjusted rate, 23.2% vs. 9.1%; adjusted hazard ratio, 3.89 [95% CI, 1.24–12.21]; P=0.02). However, there was no association between all types of HL and mortality, and between functional and communicative HL and readmission due to HF. Conclusions: Critical HL is an independent risk factor for HF readmission in patients with HF. To improve clinical outcomes in patients with HF, effective interventions should be developed to improve patient skills for critically analyzing information and making decisions.

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P6542Post-discharge worsening renal function predicts long-term adverse clinical outcomes in patients with acute heart failure

European Heart Journal ◽

10.1093/eurheartj/ehy566.p6542 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

J Y Cho ◽

K H Kim ◽

S E Lee ◽

H Y Lee ◽

J O Choi ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Clinical Outcomes ◽

Acute Heart Failure ◽

Worsening Renal Function

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073_16734-H5 The Impact of Ablation on Clinical Outcomes in Acute Heart Failure syndrome with Atrial Fibrillation

JACC: Clinical Electrophysiology ◽

10.1016/j.jacep.2017.09.114 ◽

2017 ◽

Vol 3 (10) ◽

pp. S27

Author(s):

M. Manita ◽

M. Nakata ◽

N. Higa ◽

T. Asahi ◽

K. Tabata

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Clinical Outcomes ◽

Acute Heart Failure ◽

Acute Heart Failure Syndrome ◽

The Impact

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Abstract 13815: Prognostic Impact of Sleep Disordered Breathing in Hospitalized Patients Following Acute Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.13815 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sayaki Ishiwata ◽

Takatoshi Kasai ◽

Shoko Suda ◽

Akihiro Sato ◽

Hiroki Mastumoto ◽

...

Keyword(s):

Heart Failure ◽

Clinical Outcomes ◽

Acute Heart Failure ◽

Sleep Disordered Breathing ◽

Multivariable Analysis ◽

Left Ventricular ◽

Hospitalized Patients ◽

Clinical Events ◽

Disordered Breathing

Introduction: Identifying hospitalized patients at a high risk for worse long-term clinical outcomes following acute heart failure (AHF) is important. However, limited data regarding influence of sleep-disordered breathing (SDB) and its treatment by positive airway pressure (PAP) on post-discharge clinical outcomes in hospitalized patients following AHF are available. Hypothesis: Presence of SDB may be associated with worse long-term clinical outcomes, which may be reversible by PAP therapy in patients with AHF. The aim of this study is to investigate relationship between SDB, its treatment by PAP and long-term clinical outcomes. Methods: After the initial improvement of AHF, overnight polysomnography was performed on consecutive hospitalized patients whose left ventricular (LV) ejection fraction ≤45% between May 2012 and April 2018. In the present study, SDB was defined as an apnea-hypopnea index ≥15. Patients with SDB were subdivided as those with or without PAP treatment. The incidence of deaths and re-hospitalizations due to exacerbation of heart failure until April 2019 were assessed by stepwise multivariable Cox proportional model. Results: Overall, 241 patients were enrolled. Among them, 73% had SDB and 29% were initiated into PAP. At a median follow-up of 1.7 years, 89 patients had clinical events (36.9%). In the stepwise multivariable analysis, SDB was associated with increased risk of clinical events (hazard ratio [HR], 2.20; P=0.007). Among SDB patients, stepwise multivariable analysis showed that PAP treatment was associated with reduced risk of clinical events (HR 0.45; P=0.022). Conclusions: In hospitalized patients following AHF, presence of SDB was associated with worse long-term clinical outcomes, which may be reversible by PAP therapy. Thus, following AHF, hospitalized patients with LV systolic dysfunction should be evaluated whether they have SDB and considered for SDB treatment before discharge.

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