In-Hospital Mortality in Patients With Acute Decompensated Heart Failure Requiring Intravenous Vasoactive Medications: An Analysis From the Acute Decompensated Heart Failure National Registry (ADHERE)

Introduction: There has been little focus on hospitalized acute decompensated heart failure (ADHF) that develops after admission, which may occur because of comorbid conditions, over-administration of fluid or post-surgical complications. Aims: To compare patient characteristics, case fatality, and hospital length of stay (LOS) associated with ADHF that develops after hospital admission as compared to those with ADHF at admission. Methods: Hospitalizations with possible ADHF were sampled, based on HF ICD codes, among those aged > 55 years from the four communities of the Atherosclerosis Risk in Communities Study (2005-2010). Medical records were abstracted with events classified by physician panel or computer classified. Case fatality was obtained through the National Death Index. We identified 4,503 (unweighted) events with definite/probable ADHF, after excluding those with unknown time of decompensation (n=81), hospital transfers (n=102), and race other than black or white (n=118). Demographic and clinical characteristics were compared by ADHF onset (at/after admission). Logistic regression was used to evaluate the association of ADHF onset with in-hospital mortality, and 28-days and one-year mortality, adjusted for demographics and comorbidity. Linear regression was used to evaluate the association of ADHF onset with log-transformed hospital LOS, adjusted for demographics. All analyses were weighted to account for the stratified sampling design. Results: Of 21,052 (weighted) ADHF events, 7.4% (n=1561) developed ADHF after admission. Patients with ADHF occurring after admission were older (mean: 79 vs. 75 years), and more likely white and female. Those with ADHF at admission were more likely to have a positive smoking history, COPD, and to be on dialysis. Presence of diabetes, hypertension and coronary artery disease were not significantly different between groups. In hospital mortality (16.5% vs. 6.3%; OR= 2.7, 95% CI=1.9-3.8) and 28-day mortality (23.9% vs. 10.1%; OR= 2.4, 95% CI=1.7-3.4) was higher among those who developed ADHF after admission. One-year case fatality was similar (39.4% vs. 33.6%; OR= 1.2, 95% CI=0.9-1.6). Unadjusted mean LOS was longer for those with ADHF occurring after admission (12.8 days, 95% CI=11.8-13.8) than those with ADHF at admission (7.2 days, 95% CI=6.8-7.6). The adjusted and geometric mean LOS was 1.3 days (95% CI=1.2-1.4) longer for those who developed ADHF after admission. Conclusion: Although patients with ADHF onset after admission were slightly older, differences in comorbidity do not indicate an easily identifiable subgroup for closer in-hospital monitoring. Development of ADHF after admission was associated with an alarmingly high early case fatality and longer hospital LOS compared to those with ADHF at hospital admission.

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Admission hypoxia-inducible factor 1α levels and in-hospital mortality in patients with acute decompensated heart failure

BMC Cardiovascular Disorders ◽

10.1186/s12872-015-0073-6 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 5

Author(s):

Gang Li ◽

Wei-hua Lu ◽

Xiao-wei Wu ◽

Jian Cheng ◽

Rong Ai ◽

...

Keyword(s):

Heart Failure ◽

Hospital Mortality ◽

Acute Decompensated Heart Failure ◽

Hypoxia Inducible Factor ◽

Decompensated Heart Failure ◽

Hypoxia Inducible Factor 1Α

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Usefulness of the society for cardiovascular angiography and intervention classification for predicting in-hospital mortality in patients with acute decompensated heart failure

European Heart Journal ◽

10.1093/ehjci/ehaa946.1185 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Burgos ◽

L Talavera ◽

R Baro Vila ◽

A Acosta ◽

M Cabral ◽

...

Keyword(s):

Heart Failure ◽

Hospital Mortality ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Coronary Syndrome ◽

Vasoactive Medication ◽

Staging Classification

Abstract Introduction Recently a multidisciplinary group of the Society for Cardiovascular Angiography and Interventions (SCAI) derived a new classification schema for cardiogenic shock (CS), simple, clinically based and suitable for rapid assessment at the bedside but also arbitrary. Validation in different clinical datasets, specifically in patients with acute decompensated heart failure (ADHF), is necessary to establish the utility of this proposed classification schema. Purpose We aimed to evaluate the ability of a new SCAI CS staging classification to predict in-hospital mortality in patients with ADHF. Methods We conducted a single-center cohort study, performing a retrospective analysis of prospectively collected data of consecutive patients admitted with ADHF as a primary diagnosis between January 2015 and January 2019. We excluded patients who were hospitalized for an acute coronary syndrome. Patients were assigned to the modified SCAI Classification for CS: Stage A is “at risk” for CS, stage B is “beginning” shock, stage C is “classic”, stage D is “deteriorating”, and E is “extremis”, and in-hospital mortality was evaluated for each group. All-cause mortality was compared across SCAI stages using Kaplan-Meier analysis and log-rank test. Cox proportional hazards models were used to determine the association between SCAI stages and in-hospital mortality after adjusting for age, gender, left ventricular ejection fraction, use of vasoactive medication, mechanical circulatory assist devices, mechanical ventilation, percutaneous coronary intervention and cardiac surgery. Results Among 668 patients with a mean age of 74.9±12 years, 63.9% were male. In-hospital mortality was 11.2%. According to SCAI classification, the proportion of patients in stages A through E was 51.7%, 26.7%, 14.4%, 4.6% and 2.5%. The unadjusted mortality in each stages was: A 0.6%, B 4.5%, C 32.3%, D 61.3%, and E 88.2% (Log Rank P<0.0001). After multivariable adjustment, each SCAI shock stage remained associated with increased in-hospital mortality (all P<0.001 compared to stage A). Compared with SCAI shock stage A, adjusted hazard ratio (HR) values in SCAI shock stages B through E were 5.2, 31, 107, and 185, respectively (Figure). Conclusion In this large clinical cohort of patients with ADHF exclusively, the new SCAI CS staging classification was associated with in-hospital mortality. This finding supports the rationale of the classification in this setting, further prospective trials are needed to validate these findings. Adjusted in-hospital Mortality as a Func Funding Acknowledgement Type of funding source: None

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Utility of Complete Blood Picture for Predicting In-hospital Mortality in Patients with Acute Decompensated Heart Failure with Dilated Cardiomyopathy

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0037-1607035 ◽

2017 ◽

Vol 02 (03) ◽

pp. 044-048

Author(s):

Dangeti Rao ◽

Garre Indrani ◽

M. RaviKiran

Keyword(s):

Heart Failure ◽

Hospital Mortality ◽

Eosinophil Count ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Mean Corpuscular Hemoglobin ◽

Index Hospitalization ◽

Corpuscular Hemoglobin ◽

Blood Picture ◽

Group 1

Background Congestive heart failure (CHF) is one of the leading causes of acute hospital admissions. Despite recent advances in heart failure therapy, prognosis is still poor, rehospitalization rate is very high, and quality of life is worse. It is important to identify patients at increased risk of adverse events. We tried to investigate role of components of complete blood picture on in-hospital mortality in patients hospitalized with heart failure. Methods It was an observational study of consecutive patients who admitted with a diagnosis of acute decompensated heart failure (ADHF) with dilated cardiomyopathy (DCM) in the our department between January 1, 2016 and December 31, 2016, age above 18 years. Ischemic cardiomyopathy was ruled by doing coronary angiograms either in this admission or previously known. Baseline investigations including complete blood picture were done and the patients were followed up till discharge or in hospital mortality. Results A total of 74 patients (female:male::24:50) enrolled into the study (mean age 51.86 ± 13.5 years) in 12 months. A total of 8 (10.8%) patients died during hospitalization. Among the 74 heart failure patients, 24 (32.5%) had anemia. Group 1 included patients who died during index hospitalization (n = 8) and group 2 comprised patients who were discharged in a stable condition after index hospitalization (n = 66). Group 1 patients had low hemoglobin (12.34 ± 2.93 vs. 14.4 ± 0.21 g/dL, p = 0.000) and high leukocyte count (11,600 ± 2,780 vs. 9,047 ± 3,355 cells/mcL, p = 0.040) with more eosinophils (1 ± 1.06 vs. 4.16 ± 3.48%, p = 0.000) and lymphocytes (20.5 ± 0.53 vs. 17.56 ± 7.45%, p = 0.002). Regression analysis showed a significant association between low hemoglobin and low packed cell volume (PCV) with in-hospital mortality. Mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV) rather than mean corpuscular hemoglobin concentration (MCHC) predicted worse outcome. There was a significantly higher risk of in-hospital mortality with increasing eosinophil count. On the other hand, there was no association between platelet count, total white blood cell (WBC) count, neutrophil, monocyte, or lymphocyte count with clinical outcome. Conclusion Low hemoglobin, low PCV, and high eosinophil count have been shown to predict in-hospital mortality. Complete blood picture can, therefore, be utilized in risk-stratifying patients with ADHF due to DCM.

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