Abstract 17212: 30-day All-cause Readmission is Associated With a Significantly Higher Subsequent All-cause Mortality and Costly Readmissions Among Older Medicare Beneficiaries Hospitalized for Heart Failure

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Cherinne Arundel ◽  
Rahul Khosla ◽  
Charles Faselis ◽  
Charity J Morgan ◽  
Sijian Zhang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Propensity Scores ◽  
Matched Cohort ◽  
Medicare Beneficiaries ◽  
Post Discharge ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Cumulative Length

Background: Among ambulatory patients with heart failure (HF), hospital admission is associated with higher subsequent mortality. HF is the leading cause of 30-day all-cause readmission, reduction of which is a goal of the Affordable Care Act. We examined the association of 30-day all-cause readmission with subsequent all-cause mortality in a propensity-matched cohort of hospitalized HF patients. Methods: Of the 8049 Medicare beneficiaries hospitalized for HF and discharged alive from 106 U.S. hospitals (1998-2001), 7578 were alive 30-day post-discharge, of which 1519 had 30-day all-cause readmission. Using propensity scores for 30-day all-cause readmission, we assembled a matched cohort of 1516 pairs of patients with and without 30-day all-cause readmission, balanced on 34 baseline characteristics. Results: During 2-12 months of post-discharge follow-up, all-cause mortality occurred in 41% and 27% of matched patients with and without 30-day all-cause readmission, respectively (HR, 1.68; 95% CI, 1.48-1.90; p<0.001; Figure). During a mean post-index follow up of 3 (max 9) years, patients with 30-day all-cause readmissions (vs. without) had higher total of post-index readmissions (mean, 6.9 vs 5.1; p<0.001), longer cumulative length of stay (mean, 51 vs 43 days; p<0.001), and higher charges (mean, $129,175 vs. $114,787; p=0.012) and payments (mean, $38,972 vs. $34,025; p=0.001) from those readmissions. Conclusions: Among hospitalized patients with HF 30-day all-cause readmission is associated with higher subsequent mortality, number of readmissions and costs, and longer cumulative length of stay.

Abstract 17143: Shorter Length of Stay is Associated With Significantly Lower 30-day All-cause Readmission and 30-day All-cause Mortality in Older Medicare Beneficiaries Hospitalized for Heart Failure

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Cherinne Arundel ◽  
Ali Ahmed ◽  
Rahul Khosla ◽  
Charles Faselis ◽  
Charity Morgan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Prospective Payment System ◽  
Early Discharge ◽  
Continuous Variable ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Medicare Beneficiaries ◽  
Post Discharge ◽  
All Cause Mortality

Background: A shorter hospital length of stay, encouraged by Prospective Payment System Act, may result in suboptimal care and early discharge. Heart failure (HF) is the leading cause for 30-day all-cause readmission. However, it is unknown whether hospitalized HF patients with a shorter length of stay may have higher 30-day all-cause readmission, the reduction of which is a goal of the Affordable Care Act. Methods: The 8049 Medicare beneficiaries hospitalized for HF and discharged alive from 106 U.S. hospitals (1998-2001) had a median length of stay of 5 days (interquartile, 4-8 days), of which 4272 (53%) had length of stay ≤ 5 days. Using propensity scores for length of stay 1-5 days, we assembled a matched cohort of 2788 pairs of patients with length of stay 1-5 and ≥6 days, balanced on 32 baseline characteristics. Results: 30-day all-cause readmission occurred in 19% and 23% of matched patients with length of stay 1-5 and ≥6 days, respectively (HR, 0.79; 95% CI, 0.70-0.89; Figure, left panel). When the length of stay of the 8049 pre-match patients was used as a continuous variable and adjusted for the same 32 variables, each day longer hospital stay was associated with a 2% higher risk of 30-day all-cause readmission (HR, 1.02; 95% CI, 1.01-1.03; p<0.001). Among matched patients, HR for 30-day HF readmission associated with length of stay 1-5 days was 0.84 (95% CI, 0.69-1.01; p=0.063). 30-day all-cause mortality occurred in 4.6% and 6.2% of matched patients with length of stay 1-5 and ≥6 days, respectively (HR, 0.73; 95% CI, 0.58-0.91; Figure, right panel). These associations persisted throughout 12 months post-discharge. Conclusions: Among hospitalized patients with HF, length of stay 1-5 days (vs. longer) was associated with significantly lower 30-day all-cause readmissions and all-cause mortality that persisted throughout first year post-discharge.

scholarly journals Prediction of all-cause mortality with malnutrition assessed by controlling nutritional status score in patients with heart failure: a systematic review and meta-analysis

2021 ◽  
pp. 1-8
Author(s):  
Huiyang Li ◽  
Peng Zhou ◽  
Yikai Zhao ◽  
Huaichun Ni ◽  
Xinping Luo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Nutritional Status ◽  
Meta Analysis ◽  
Predictive Values ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Conut Score

Abstract Objective: The aim of this meta-analysis was to investigate the association between malnutrition assessed by the controlling nutritional status (CONUT) score and all-cause mortality in patients with heart failure. Design: Systematic review and meta-analysis. Settings: A comprehensively literature search of PubMed and Embase databases was performed until 30 November 2020. Studies reporting the utility of CONUT score in prediction of all-cause mortality among patients with heart failure were eligible. Patients with a CONUT score ≥2 are grouped as malnourished. Predictive values of the CONUT score were summarized by pooling the multivariable-adjusted risk ratios (RR) with 95 % CI for the malnourished v. normal nutritional status or per point CONUT score increase. Participants: Ten studies involving 5196 patients with heart failure. Results: Malnourished patients with heart failure conferred a higher risk of all-cause mortality (RR 1·92; 95 % CI 1·58, 2·34) compared with the normal nutritional status. Subgroup analysis showed the malnourished patients with heart failure had an increased risk of in-hospital mortality (RR 1·78; 95 % CI 1·29, 2·46) and follow-up mortality (RR 2·01; 95 % CI 1·58, 2·57). Moreover, per point increase in CONUT score significantly increased 16% risk of all-cause mortality during the follow-up. Conclusions: Malnutrition defined by the CONUT score is an independent predictor of all-cause mortality in patients with heart failure. Assessment of nutritional status using CONUT score would be helpful for improving risk stratification of heart failure.

scholarly journals Aspartate aminotransferase to alanine aminotransferase ratio is associated with frailty and mortality in older patients with heart failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Daichi Maeda ◽  
Nobuyuki Kagiyama ◽  
Kentaro Jujo ◽  
Kazuya Saito ◽  
Kentaro Kamiya ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Patients ◽  
Early Recognition ◽  
Walk Distance ◽  
Failure Data ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
One Year ◽  
Independent Marker

AbstractFrailty is a common comorbidity associated with adverse events in patients with heart failure, and early recognition is key to improving its management. We hypothesized that the AST to ALT ratio (AAR) could be a marker of frailty in patients with heart failure. Data from the FRAGILE-HF study were analyzed. A total of 1327 patients aged ≥ 65 years hospitalized with heart failure were categorized into three groups based on their AAR at discharge: low AAR (AAR < 1.16, n = 434); middle AAR (1.16 ≤ AAR < 1.70, n = 487); high AAR (AAR ≥ 1.70, n = 406). The primary endpoint was one-year mortality. The association between AAR and physical function was also assessed. High AAR was associated with lower short physical performance battery and shorter 6-min walk distance, and these associations were independent of age and sex. Logistic regression analysis revealed that high AAR was an independent marker of physical frailty after adjustment for age, sex and body mass index. During follow-up, all-cause death occurred in 161 patients. After adjusting for confounding factors, high AAR was associated with all-cause death (low AAR vs. high AAR, hazard ratio: 1.57, 95% confidence interval, 1.02–2.42; P = 0.040). In conclusion, AAR is a marker of frailty and prognostic for all-cause mortality in older patients with heart failure.

Evaluation of a multimarker panel in chronic heart failure: a 10-year follow-up

2021 ◽  
Author(s):  
Susanne Bauer ◽  
Christina Strack ◽  
Ekrem Ücer ◽  
Stefan Wallner ◽  
Ute Hubauer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Prognostic Role ◽  
Blood Samples ◽  
Kaplan Meier ◽  
Risk Of Mortality ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Long Time

Aim: We assessed the 10-year prognostic role of 11 biomarkers with different pathophysiological backgrounds. Materials & methods/results: Blood samples from 144 patients with heart failure were analyzed. After 10 years of follow-up (median follow-up was 104 months), data regarding all-cause mortality were acquired. Regarding Kaplan–Meier analysis, all markers, except TIMP-1 and GDF-15, were significant predictors for all-cause mortality. We created a multimarker model with nt-proBNP, hsTnT and IGF-BP7 and found that patients in whom all three markers were elevated had a significantly worse long-time-prognosis than patients without elevated markers. Conclusion: In a 10-year follow-up, a combination of three biomarkers (NT-proBNP, hs-TnT, IGF-BP7) identified patients with a high risk of mortality.

P2630Incidence and prognostic impact of new-onset left bundle branch block in patients with heart failure and reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S L Kristensen ◽  
R Roerth ◽  
P S Jhund ◽  
S Beggs ◽  
L Kober ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Qrs Duration ◽  
New Onset

Abstract Background Cardiac resynchronization therapy (CRT) improves survival in patients with heart failure, reduced ejection fraction (HFrEF) and left bundle branch block (LBBB). However, little is known about the incidence of LBBB in HFrEF and the risk factors for developing this. We addressed these questions in the PARADIGM-HF and ATMOSPHERE trials. Methods We identified 7703 patients with a non-paced rhythm on their baseline ECG, a QRS<130 ms, and at least one follow-up ECG (done at annual visits and end of study). Patients were stratified by baseline QRS duration (≤100 ms - reference; 101–115 ms and 116–129 ms) and followed until development of QRS duration ≥130 ms with a LBBB configuration or latest available ECG. The crude LBBB incidence rate per 100 person-years (py) was identified in the three QRS duration subgroups. Additionally, we examined risk of the primary composite outcome of cardiovascular death or HF hospitalization, and all-cause mortality, in patients with incident LBBB vs. no incident LBBB. Results Overall, 313 of 7703 patients (4%) developed LBBB during a mean follow-up of 2.7 years, yielding an incidence rate of 1.5 per 100 py. The rate ranged from 0.9 in those with QRS ≤100 ms to 4.0 per 100 py in patients with QRS 116–129 ms. Other predictors of incident LBBB included male sex, age, lower LVEF, HF duration and absence of AF. The risk of the primary composite endpoint was higher among those who developed incident LBBB vs no incident LBBB; event rates 13.5 vs 10.0 per 100 py, yielding an adjusted HR of 1.43 (1.05–1.96). For all-cause mortality the corresponding rates were 12.6 vs 7.3 per 100 py; HR 1.55 (1.16–2.07) (Table 1). Table 1. Risk of outcomes according to incident LBBB during follow-up No. events Crude rate per 100py Adjusted* HR (95% CI) HF hospitalization or CV death   No incident LBBB 2145 10.0 (9.6–10.4) 1.00 (ref.)   Incident LBBB 43 13.5 (10.0–18.2) 1.43 (1.05–1.96) All-cause mortality   No incident LBBB 1662 7.3 (6.9–7.6) 1.00 (ref.)   Incident LBBB 48 12.6 (9.5–16.7) 1.55 (1.16–2.07) Conclusion Among patients with HFrEF, the annual incidence of new-onset LBBB (and a potential indication for CRT), was around 1.5%, ranging from 1% in those with QRS duration below 100 ms to 4% in those with QRS 116–129 ms. Incident LBBB was associated with a much higher risk of adverse outcomes, highlighting the importance of repeat ECG monitoring in patients with HFrEF. Acknowledgement/Funding Novartis

scholarly journals Relationship between skin autofluorescence levels and clinical events in patients with heart failure undergoing cardiac rehabilitation

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Mitsuhiro Kunimoto ◽  
Miho Yokoyama ◽  
Kazunori Shimada ◽  
Tomomi Matsubara ◽  
Tatsuro Aikawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Cox Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Skin Autofluorescence ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Abstract Background Advanced glycation end-products, indicated by skin autofluorescence (SAF) levels, could be prognostic predictors of all-cause and cardiovascular mortality in patients with diabetes mellitus (DM) and renal disease. However, the clinical usefulness of SAF levels in patients with heart failure (HF) who underwent cardiac rehabilitation (CR) remains unclear. This study aimed to investigate the associations between SAF and MACE risk in patients with HF who underwent CR. Methods This study enrolled 204 consecutive patients with HF who had undergone CR at our university hospital between November 2015 and October 2017. Clinical characteristics and anthropometric data were collected at the beginning of CR. SAF levels were noninvasively measured with an autofluorescence reader. Major adverse cardiovascular event (MACE) was a composite of all-cause mortality and unplanned hospitalization for HF. Follow-up data concerning primary endpoints were collected until November 2017. Results Patients’ mean age was 68.1 years, and 61% were male. Patients were divided into two groups according to the median SAF levels (High and Low SAF groups). Patients in the High SAF group were significantly older, had a higher prevalence of chronic kidney disease, and more frequently had history of coronary artery bypass surgery; however, there were no significant between-group differences in sex, prevalence of DM, left ventricular ejection fraction, and physical function. During a mean follow-up period of 590 days, 18 patients had all-cause mortality and 36 were hospitalized for HF. Kaplan–Meier analysis showed that patients in the high SAF group had a higher incidence of MACE (log-rank P < 0.05). After adjusting for confounding factors, Cox regression multivariate analysis revealed that SAF levels were independently associated with the incidence of MACE (odds ratio, 1.86; 95% confidence interval, 1.08–3.12; P = 0.03). Conclusion SAF levels were significantly associated with the incidence of MACE in patients with HF and may be useful for risk stratification in patients with HF who underwent CR.

scholarly journals Early Increased Physical Activity, Cardiac Rehabilitation, and Survival After Implantable Cardioverter-Defibrillator Implantation

2021 ◽  
Author(s):  
Brett D. Atwater ◽  
Zhen Li ◽  
Jessica Pritchard ◽  
Melissa A. Greiner ◽  
Yelena Nabutovsky ◽  
...  
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Propensity Scores ◽  
Time Frame ◽  
Hazard Ratio ◽  
Implantable Cardioverter Defibrillators ◽  
Medicare Beneficiaries ◽  
Icd Implantation ◽  
All Cause Mortality

Background: Increased physical activity (PA) through cardiac rehabilitation (CR) improves outcomes in patients with heart failure and coronary disease, but CR referral remains infrequent. Implantable cardioverter-defibrillators (ICDs) can provide daily PA measurements to patients that may motivate them to increase PA, but it remains unclear if increased ICD measured PA is associated with improved outcomes with and without CR. Methods: This is a retrospective observational study of 41 731 Medicare beneficiaries with ICD implantation between January 1, 2014 and December 31, 2016. We linked daily ICD PA measurements and Medicare claims data to determine if increased PA is associated with a reduction in the likelihood of death or heart failure hospitalization. To determine if CR participation altered the effect of PA on outcomes, we performed two additional analyses matching CR participants and nonparticipants using propensity scores. The first match included demographics, comorbidities, and baseline PA measurements. The second match also included the change in PA measured during CR or the same time frame after ICD implant among nonparticipants. Results: The mean age was 75 (SD, 10) years, 30 182 beneficiaries (72.3%) were male, and 1324 (3%) participated in CR. Increased ICD detected PA was associated with improved survival. CR participants had a mean PA change of +9.7 (SD, 57.8) min/d, whereas nonparticipants had a mean change of −1.0 (SD, 59.7) min/d ( P <0.001). After matching for demographics, comorbidities and baseline PA, CR participants had significantly lower 1- to 3-year mortality (hazard ratio, 0.76 [95% CI, 0.69–0.85], P =0.03). After additionally matching for the ICD measured change in PA during CR there were no differences in mortality with and without CR (hazard ratio, 1.00 [95% CI, 0.82–1.21], P =0.87). Every 10 minutes of increased daily PA was associated with a 1.1% reduction in all-cause mortality in both groups. Conclusions: Among Medicare beneficiaries with ICDs, small increases in PA were associated with significant reductions in all-cause mortality.

Abstract 12930: Low Urine Sodium (UNa) Early After Heart Failure Admission Predicts Long Length of Stay and Early Mortality

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Adriana Luk ◽  
John D Groarke ◽  
Deepa M Gopal ◽  
Emer Joyce ◽  
Sachin P Shah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Diuretic Therapy ◽  
Spot Urine ◽  
Risk Of Death ◽  
Patients With Heart Failure ◽  
Hemodynamic Profile ◽  
Heart Failure Admission ◽  
Primary Focus

Background: Although decongestion is the primary focus of acute heart failure (HF) management, the degree of natriuretic response to diuretic therapy varies and may predict length of stay (LOS) and early outcomes. We hypothesize that a UNa &lt60 mmol/L, measured after initial intravenous (IV) diuretic administration, would be associated with longer duration of IV diuretic, longer LOS, increased use of inotropic therapy in hospital and higher risk of death. Methods and Results: From July 1, 2014-May 30, 2015, we enrolled 100 unique patients hospitalized to the advanced HF service for decompensated HF. Dose of IV diuretic was based on their daily oral home dose. Spot urine samples were collected within a median of 98 (0-187) minutes after initial diuretic therapy. Patients with UNa &lt60 mmol/L (n=30) had significantly lower serum sodium and higher admission NT-proBNP than those with UNa &gt60 mmol/L (n=70). As well, they were more commonly rated with hemodynamic profile C (“cold and wet”, 40.0 vs.11.4%, p=0.002) and INTERMACS profile 3-4 (30.0 vs. 12.9%, p= 0.04). During the hospital stay, patients with low initial UNa required longer use of IV diuretic therapy (9.5 vs. 5.0 days, p&lt0.0001) and had a longer median LOS (12.0 vs. 6.0 days, p&lt 0.0001) than those with high UNa. After adjusting for eGFR, UNa &lt60 mmol/L was still associated with a higher likelihood of inotropic usage in hospital (hazard ratio [HR] 9.91 (3.27-30.05); p&lt0.0001) and death (HR 3.14 (1.20-8.23); p=0.004) at a median follow-up period of 85 (38-159) days (figure 1). Conclusions: Low UNa after initial IV diuretic administration identifies a population of acute HF patients with advanced disease who have longer LOS and are at high risk for death. Measurement of UNa after first diuretic therapy may help to facilitate triage of patients with heart failure and anticipate the need for advanced HF therapies

Abstract 17157: Clinical Impact of Digoxin Discontinuation at Hospital Discharge in Patients With Heart Failure With Reduced Ejection Fraction

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Fahad Lodhi ◽  
Awais Malik ◽  
Syed Z Qamer ◽  
Cherinne Arundel ◽  
Helen Sheriff ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Hospital Discharge ◽  
Propensity Scores ◽  
Clinical Impact ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
African America ◽  
Discharge From Hospital

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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