Precipitating factors and clinical impact of early rehospitalization for heart failure in patients with heart failure in Awaji Island, Japan

Introduction: Digoxin use is associated with a lower risk of hospital admission and readmission in patients with heart failure with reduced ejection fraction (HFrEF). Moreover, PROVED and RADIANCE trials have shown that digoxin discontinuation is associated with lower ejection fraction (EF), higher heart rate, and worse heart failure (HF) symptoms in chronic HFrEF patients. Despite these results, digoxin use has declined over recent years. In this study, we examined the clinical impact of digoxin discontinuation at hospital discharge in elderly patients with HFrEF. Hypothesis: Digoxin discontinuation at hospital discharge will increase mortality and heart failure readmission in HFrEF patients. Methods: Of 10,625 patients hospitalized with HFrEF (EF≤40%) in Medicare-linked OPTIMIZE-HF registry, 3,225 were receiving digoxin prior to admission but it was discontinued in 655 of these patients at the time of discharge. Propensity scores for digoxin discontinuation, estimated for each of the 3,225 patients, were used to match 616 pairs of patients (digoxin continued vs. discontinued) balanced on 60 baseline characteristics including age (mean 76 years), EF (mean 26%), gender (31% females) and race (15% African America) among others. Results: Among 1,232 matched patients, digoxin discontinuation was associated with a higher risk of all-cause mortality at 30-days (12% vs. 8%; HR 1.45; 95% CI 1.01-2.07; p=0.044) and 6-months (HR 1.32; p=0.009) but not at 1-year (HR 1.18; p=0.07). Digoxin discontinuation was also associated with increased combined heart failure readmission/all-cause mortality at 4-years of follow up (HR 1.16; 95% CI 1.03-1.30; p=0.017). Conclusions: In patients with HFrEF receiving digoxin prior to admission, digoxin discontinuation at discharge from hospital is associated with increased short-term all-cause mortality and long-term heart failure readmission/all-cause mortality.

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Precipitating Factors for Hospitalization with Heart Failure: Prevalence and Clinical Impact Observations from the Gulf CARE (Gulf aCute heArt failuRe rEgistry)

Medical Principles and Practice ◽

10.1159/000503334 ◽

2019 ◽

Vol 29 (3) ◽

pp. 270-278

Author(s):

Amar M. Salam ◽

Kadhim Sulaiman ◽

Alawi A. Alsheikh-Ali ◽

Rajvir Singh ◽

Khalid F. AlHabib ◽

...

Keyword(s):

Heart Failure ◽

Middle East ◽

Acute Heart Failure ◽

Middle Eastern ◽

Clinical Impact ◽

Therapeutic Interventions ◽

Inhospital Mortality ◽

Precipitating Factors ◽

Coronary Syndromes ◽

New Onset

Objective: Despite the expanding burden of heart failure (HF) worldwide, data on HF precipitating factors (PFs) in developing countries, particularly the Middle East, are very limited. We examined PFs in patients hospitalized with acute HF in a prospective multicenter HF registry from 7 countries in the Middle East. Method: Data were derived from the Gulf CARE (Gulf aCute heArt failuRe rEgistry) for a prospective, multinational, multicenter study of consecutive patients hospitalized with HF in 47 hospitals in 7 Middle Eastern countries between February 2012 and November 2012. PFs were determined by the treating physician from a predefined list at the time of hospitalization. Results: The study included 5,005 patients hospitalized with acute HF, 2,276 of whom (45.5%) were hospitalized with acute new-onset HF (NOHF) and 2,729 of whom (54.5%) had acute decompensated chronic HF (DCHF). PFs were identified in 4,319 patients (86.3%). The most common PF in the NOHF group was acute coronary syndromes (ACS) (39.2%). In the DCHF group, it was noncompliance with medications (27.8%). Overall, noncompliance with medications was associated with a lower inhospital mortality (OR 0.47; 95% CI 0.28–0.80; p = 0.005) but a higher 1-year mortality (OR 1.43; 95% CI 1.1–1.85; p = 0.007). ACS was associated with higher inhospital mortality (OR 1.84; 95% CI 1.26–2.68; p = 0.002) and higher 1-year mortality (OR 1.62; 95% CI 1.27–2.06; p = 0.001). Conclusion: Preventive and therapeutic interventions specifically directed at noncompliance with medications and ACS are warranted in our region.

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