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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 curve for NYHA functional class 4 as independent predictor for 1-year mortality in elderly patients with HFREF.Abbreviations: AUC, area under the curve; HFREF, heart failure with reduced ejection fraction; NYHA, New York Heart Association; ROC, receiver operating characteristic.
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f3-cia-10-561: ROC curve for NYHA functional class 4 as independent predictor for 1-year mortality in elderly patients with HFREF.Abbreviations: AUC, area under the curve; HFREF, heart failure with reduced ejection fraction; NYHA, New York Heart Association; ROC, receiver operating characteristic.

Mentions: During the 1-year follow-up period, seven deaths occurred (9.8%), of which four (5.6%) were assessed as having cardiovascular causes, while three (4.2%) were noncardiovascular. The only independent predictive variable for mortality was an NYHA functional class 4 at baseline hospitalization (P=0.001). The ROC curve for this variable is presented in Figure 3 (sensitivity =85.7; specificity =65.6; AUC =0.757).


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 curve for NYHA functional class 4 as independent predictor for 1-year mortality in elderly patients with HFREF.Abbreviations: AUC, area under the curve; HFREF, heart failure with reduced ejection fraction; NYHA, New York Heart Association; ROC, receiver operating characteristic.
© Copyright Policy
Related In: Results  -  Collection

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

f3-cia-10-561: ROC curve for NYHA functional class 4 as independent predictor for 1-year mortality in elderly patients with HFREF.Abbreviations: AUC, area under the curve; HFREF, heart failure with reduced ejection fraction; NYHA, New York Heart Association; ROC, receiver operating characteristic.
Mentions: During the 1-year follow-up period, seven deaths occurred (9.8%), of which four (5.6%) were assessed as having cardiovascular causes, while three (4.2%) were noncardiovascular. The only independent predictive variable for mortality was an NYHA functional class 4 at baseline hospitalization (P=0.001). The ROC curve for this variable is presented in Figure 3 (sensitivity =85.7; specificity =65.6; AUC =0.757).

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