Elsevier

American Heart Journal

Volume 154, Issue 2, August 2007, Pages 260-266
American Heart Journal

Clinical Investigation
Congestive Heart Failure
Repeated hospitalizations predict mortality in the community population with heart failure

https://doi.org/10.1016/j.ahj.2007.01.041Get rights and content

Background

Identification of patients at high risk of death is critical for appropriate management of patients and health care resources. The impact of repeated heart failure (HF) hospitalization on mortality has not been studied for a large community population with HF. We aimed to characterize survival of patients in relation to the number of HF hospitalizations.

Method

Using the health care utilization databases, we identified a cohort of patients with a first hospitalization for HF among all residents of British Columbia between 2000 and 2004. Survival time was measured after patients' first and each subsequent HF hospitalization. Kaplan-Meier cumulative mortality curves were constructed after each subsequent HF hospitalization. Hazard ratios for the number of HF hospitalizations were estimated using a multivariate Cox regression adjusting for major comorbidities.

Results

Of 14 374 patients hospitalized for HF, 7401 died during the 24 766 person-years of follow-up. Mortality significantly increased after each HF hospitalization. After adjusting for age, sex, and major comorbidities, the number of HF hospitalizations was a strong predictor of all-cause death. Median survival after the first, second, third, and fourth hospitalization was 2.4, 1.4, 1.0, and 0.6 years. Advanced age, renal disease, and history of cardiac arrest attenuated the impact of the number of HF hospitalizations.

Conclusions

The number of HF hospitalizations is a strong predictor of mortality in community HF patients. This simple predictor of mortality in HF patients should help triage management and resources for HF and trigger patient planning for prognosis.

Section snippets

Data sources

We used health care utilization databases that contain information on discharge abstract, outpatient diagnoses, and procedure codes for all residents of British Columbia, Canada, from 1996 to 2004, where the Canadian national insurance system provides comprehensive coverage for health care for all including the elderly and disabled. These data sources provide basic demographic information, as well as coded diagnostic, procedural, and pharmacy dispensing information with high accuracy.12 The

Study population and its characteristics

We identified a cohort of 14,374 patients who were hospitalized for HF for the first time during January 1, 2000, to December 31, 2004. Characteristics of the study population are summarized in Table I. The mean age of the cohort was >75 years, reflecting the high incidence of HF in the elderly population. Patients had a high prevalence of comorbid conditions, including other cardiovascular diseases, diabetes, chronic pulmonary diseases, and CKD. Of 14,374 patients, 3,358 patients had second,

Discussion

Among 14,374 patients with repeated HF hospitalizations, mortality increased sharply with recurrent HF hospitalizations. The number of repeated HF hospitalizations remained a strong independent predictor of mortality even after adjusting for other major risk factors for mortality among HF patients. However, the effects of the number of repeated HF hospitalizations were diminished with advanced age, presence of CKD, and history of cardiac arrest.

History and timing of prior HF hospitalization

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This project was supported by grants from the National Institute on Aging (R01-AG021950) and from the Agency for Healthcare Research and Quality (2-RO1-HS10881), Department of Health and Human Services, Rockville, MD.

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