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Factors associated with prolonged hospitalization, readmission, and death in elderly heart failure patients in western Romania.

Gyalai-Korpos I, Ancusa O, Dragomir T, Tomescu MC, Marincu I - Clin Interv Aging (2015)

Bottom Line: The variables associated with outcomes were analyzed in univariate and multivariate logistic regression.During the multivariate analysis, it was found that the independent predictors of readmissions were the presence of comorbidities (P<0.001) and prolonged baseline hospitalization (P<0.01).The 1-year mortality rate was 9.8%, with no significant difference between cardiovascular (5.6%) and noncardiovascular (4.2%) deaths.

View Article: PubMed Central - PubMed

Affiliation: University of Medicine and Pharmacy, Timisoara, Romania ; Cardiology Department, City Hospital, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.

ABSTRACT

Purpose: The purpose of this prospective study was to identify factors associated with prolonged hospitalization, readmission, and death in elderly patients presenting heart failure with reduced ejection fraction.

Patients and methods: All consecutive patients aged ≥65 years discharged with a diagnosis of acute new-onset heart failure and a left ventricular ejection fraction (LVEF) ≤45% were included and followed up for 1 year. The variables associated with outcomes were analyzed in univariate and multivariate logistic regression. For the independent predictors identified by multivariate analysis, receiver operating characteristic (ROC) analysis was performed.

Results: A total of 71 patients were included in the study. The patient mean age was 72.5 years, 50% were female, and the mean LVEF was 31.25%±5.76%. In all, 34 (48%) patients experienced prolonged hospitalization, and this was independently associated with patients who were living in a rural area (P=0.005), those with a New York Heart Association functional class of 4 (P<0.001), the presence of comorbidities (P=0.023), chronic obstructive pulmonary disease (COPD) infectious exacerbation (P<0.001), and chronic kidney disease (P=0.025). In the multivariate analysis, only COPD infectious exacerbation was independently associated with prolonged hospitalization (P=0.003). A total 19 patients (27%) experienced readmissions during the 1-year follow up, of which 12 (17%) had cardiovascular causes and seven (10%) had noncardiovascular causes. The following independent variables associated with rehospitalizations were outlined in the univariate analysis: infections (P<0.020); COPD infectious exacerbation (P=0.015); one or more comorbidity (P<0.0001); and prolonged baseline hospitalization (P<0.0001). During the multivariate analysis, it was found that the independent predictors of readmissions were the presence of comorbidities (P<0.001) and prolonged baseline hospitalization (P<0.01). The 1-year mortality rate was 9.8%, with no significant difference between cardiovascular (5.6%) and noncardiovascular (4.2%) deaths. The only independent predictive variable for mortality was a New York Heart Association NYHA functional class 4 at baseline hospitalization (P=0.001).

Conclusion: Elderly patients are at high risk for prolonged hospitalization, readmission, and death following a first hospitalization for heart failure with reduced ejection fraction. The most powerful predictors for outcomes are the severity of heart failure, the presence of comorbidities, and prolonged hospitalization at baseline.

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ROC curves for comorbidities and prolonged baseline hospitalization as independent predictors for 1-year readmissions in elderly patients with HFREF.Abbreviations: AUC, area under the curve; HFREF, heart failure with reduced ejection fraction; PH, prolonged hospitalization; ROC, receiver operating characteristic.
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f2-cia-10-561: ROC curves for comorbidities and prolonged baseline hospitalization as independent predictors for 1-year readmissions in elderly patients with HFREF.Abbreviations: AUC, area under the curve; HFREF, heart failure with reduced ejection fraction; PH, prolonged hospitalization; ROC, receiver operating characteristic.

Mentions: A total 19 patients (27%) experienced readmissions during the 1-year follow up, of which 12 (17%) had cardiovascular and seven (10%) had noncardiovascular causes. Univariate analysis revealed that the variables associated with rehospitalizations were the presence of any infection (P<0.020), the infectious exacerbation of COPD (P=0.015), one or more comorbidity (P<0.0001), and prolonged baseline hospitalization (P<0.0001). Multivariate logistic regression analyses indicated that the independent predictors of readmission were the presence of comorbidities (P<0.001) and prolonged hospitalization at baseline (P<0.01). As shown in Figure 2, the difference between the AUCs of the two variables was not statistically significant (P=0.60).


Factors associated with prolonged hospitalization, readmission, and death in elderly heart failure patients in western Romania.

Gyalai-Korpos I, Ancusa O, Dragomir T, Tomescu MC, Marincu I - Clin Interv Aging (2015)

ROC curves for comorbidities and prolonged baseline hospitalization as independent predictors for 1-year readmissions in elderly patients with HFREF.Abbreviations: AUC, area under the curve; HFREF, heart failure with reduced ejection fraction; PH, prolonged hospitalization; ROC, receiver operating characteristic.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4362599&req=5

f2-cia-10-561: ROC curves for comorbidities and prolonged baseline hospitalization as independent predictors for 1-year readmissions in elderly patients with HFREF.Abbreviations: AUC, area under the curve; HFREF, heart failure with reduced ejection fraction; PH, prolonged hospitalization; ROC, receiver operating characteristic.
Mentions: A total 19 patients (27%) experienced readmissions during the 1-year follow up, of which 12 (17%) had cardiovascular and seven (10%) had noncardiovascular causes. Univariate analysis revealed that the variables associated with rehospitalizations were the presence of any infection (P<0.020), the infectious exacerbation of COPD (P=0.015), one or more comorbidity (P<0.0001), and prolonged baseline hospitalization (P<0.0001). Multivariate logistic regression analyses indicated that the independent predictors of readmission were the presence of comorbidities (P<0.001) and prolonged hospitalization at baseline (P<0.01). As shown in Figure 2, the difference between the AUCs of the two variables was not statistically significant (P=0.60).

Bottom Line: The variables associated with outcomes were analyzed in univariate and multivariate logistic regression.During the multivariate analysis, it was found that the independent predictors of readmissions were the presence of comorbidities (P<0.001) and prolonged baseline hospitalization (P<0.01).The 1-year mortality rate was 9.8%, with no significant difference between cardiovascular (5.6%) and noncardiovascular (4.2%) deaths.

View Article: PubMed Central - PubMed

Affiliation: University of Medicine and Pharmacy, Timisoara, Romania ; Cardiology Department, City Hospital, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.

ABSTRACT

Purpose: The purpose of this prospective study was to identify factors associated with prolonged hospitalization, readmission, and death in elderly patients presenting heart failure with reduced ejection fraction.

Patients and methods: All consecutive patients aged ≥65 years discharged with a diagnosis of acute new-onset heart failure and a left ventricular ejection fraction (LVEF) ≤45% were included and followed up for 1 year. The variables associated with outcomes were analyzed in univariate and multivariate logistic regression. For the independent predictors identified by multivariate analysis, receiver operating characteristic (ROC) analysis was performed.

Results: A total of 71 patients were included in the study. The patient mean age was 72.5 years, 50% were female, and the mean LVEF was 31.25%±5.76%. In all, 34 (48%) patients experienced prolonged hospitalization, and this was independently associated with patients who were living in a rural area (P=0.005), those with a New York Heart Association functional class of 4 (P<0.001), the presence of comorbidities (P=0.023), chronic obstructive pulmonary disease (COPD) infectious exacerbation (P<0.001), and chronic kidney disease (P=0.025). In the multivariate analysis, only COPD infectious exacerbation was independently associated with prolonged hospitalization (P=0.003). A total 19 patients (27%) experienced readmissions during the 1-year follow up, of which 12 (17%) had cardiovascular causes and seven (10%) had noncardiovascular causes. The following independent variables associated with rehospitalizations were outlined in the univariate analysis: infections (P<0.020); COPD infectious exacerbation (P=0.015); one or more comorbidity (P<0.0001); and prolonged baseline hospitalization (P<0.0001). During the multivariate analysis, it was found that the independent predictors of readmissions were the presence of comorbidities (P<0.001) and prolonged baseline hospitalization (P<0.01). The 1-year mortality rate was 9.8%, with no significant difference between cardiovascular (5.6%) and noncardiovascular (4.2%) deaths. The only independent predictive variable for mortality was a New York Heart Association NYHA functional class 4 at baseline hospitalization (P=0.001).

Conclusion: Elderly patients are at high risk for prolonged hospitalization, readmission, and death following a first hospitalization for heart failure with reduced ejection fraction. The most powerful predictors for outcomes are the severity of heart failure, the presence of comorbidities, and prolonged hospitalization at baseline.

Show MeSH
Related in: MedlinePlus