Timing and Causes of Readmission After Acute Heart Failure Hospitalization-Insights From the Heart Failure Network Trials

JOURNAL OF CARDIAC FAILURE

卷:22

Editorial Material

Vader, Justin M.¹  LaRue, Shane J.¹  Stevens, Susanna R.²  Mentz, Robert J.²  DeVore, Adam D.²  Lala, Anuradha^3,4  Groarke, John D.⁴  AbouEzzeddine, Omar F.⁵  Dunlay, Shannon M.⁵  Grodin, Justin L.⁶  Davila-Roman, Victor G.¹  de las Fuentes, Lisa¹ 

[1] Washington Univ, Sch Med, St Louis, MO USA

[2] Duke Clin Res Inst, Durham, NC USA

[3] Mt Sinai Hosp, New York, NY 10029 USA

[4] Harvard Univ, Brigham & Womens Hosp, Boston, MA 02115 USA

[5] Mayo Clin, Rochester, MN USA

[6] Cleveland Clin, Cleveland, OH 44106 USA

关键词: Cardiorenal;    ACE inhibitor;    RAAS;   

DOI  :  10.1016/j.cardfail.2016.04.014

来源: Elsevier

【 摘 要 】

Background: Readmission or death after heart failure (HF) hospitalization is a consequential and closely scrutinized outcome, but risk factors may vary by population. We characterized the risk factors for post discharge readmission/death in subjects treated for acute heart failure (AHF). Methods and Results: A post hoc analysis was performed on data from 744 subjects enrolled in 3 AHF trials conducted within the Heart Failure Network (HFN): Diuretic Optimization Strategies Evaluation in Acute Heart Failure (DOSE-AHF), Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF), and Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE-AHF). All cause readmission/death occurred in 26% and 38% of subjects within 30 and 60 days of discharge, respectively. Non-HF cardiovascular causes of readmission were more common in the <= 30-day timeframe than in the 31-60-day timeframe (23% vs 10%, P = .016). In a Cox proportional hazards model adjusting a priori for left ventricular ejection fraction <50% and trial, the risk factors for all-cause readmission/death included: elevated baseline blood urea nitrogen, angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) non-use, lower baseline sodium, non-white race, elevated baseline bicarbonate, lower systolic blood pressure at discharge or day 7, depression, increased length of stay, and male sex. Conclusions: In an AHF population with prominent congestion and prevalent renal dysfunction, early readmissions were more likely to be due to non-HF cardiovascular causes compared with later readmissions. The association between use of ACEI/ARB and lower all-cause readmission/death in Cox proportional hazards model suggests a role for these drugs to improve post-discharge outcomes in AHF.

【 授权许可】

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