Severity of Decompensation and Post-Discharge Outcomes in First-Episode Acute Heart Failure

Decompensation severity may be associated with increased risk for adverse clinical outcomes post-hospital discharge in patients with first-episode acute heart failure (AHF), according to the results of a study published in Clinical Research in Cardiology.

In this review, data from the prospective, multicenter Epidemiology of Acute Heart Failure in Emergency Department Registry of 3422 consecutive patients (mean age, 80±11 years; 52.1% women) diagnosed with AHF and treated across 45 emergency departments in Spain were examined. In this cohort, 79% of patients had hypertension, 72% had preserved left ventricular ejection fraction, 38% had atrial fibrillation, and 37% had diabetes. Patients were evaluated at 90 days for mortality and rehospitalization.

The in-hospital mortality rate was 6.9%. Patients who died vs survived during hospitalization differed in: age (84 vs 79 years, respectively; P <.001), average Barthel Index (61 vs 84, respectively; P <.001), New York Heart Association (NYHA) class III or IV (30.5% vs 15.0%, respectively; P <.001), rate of chronic kidney failure (26.8% vs 18.3%, respectively; P <.001), dementia (34.0% vs 0.8%, respectively; P <.001), and active neoplasia (25.5% vs 14.3%, respectively; P <.001). Dementia and active neoplasia remained significantly associated with in-hospital mortality in an adjusted analysis (odds ratio [OR], 2.25; 95% CI, 1.62-3.14 and OR, 1.97; 95% CI, 1.41-2.76, respectively).

The 90-day mortality rate for patients who survived the first hospitalization was 19.3%. Hypertension (hazard ratio [HR], 1.40; 95% CI, 1.11-1.76), chronic renal insufficiency (HR, 1.23; 95% CI, 1.01-1.49), heart valve disease (HR, 1.24; 95% CI, 1.01-1.51), chronic obstructive pulmonary disease (HR, 1.22; 95% CI, 1.01-1.48), NYHA class III or IV (HR, 1.40; 95% CI, 1.12-1.74), and high-risk due to decompensation (HR, 1.64; 95% CI, 1.20-2.25) remained significant predictors of 90-day mortality in those patients in an adjusted analysis.

The 90-day rehospitalization rate was 17.4% and post-discharge death was observed for 7.6% of patients. Although several baseline characteristics were found to be associated with 90-day rehospitalization or post-discharge death, after correcting for left ventricular ejection fraction, these associations were no longer significant.

Study limitations include the fact that data for >10% of patients was missing for several variables (ie, left ventricular ejection fraction, Barthel Index, and classification of the severity of index episode), and that cause of death was not recorded, which may have led to an overestimation of the impact of AHF on mortality.

“[O]ur findings highlight the importance of stratifying patients according to risk severity and assessing basal status with NYHA functional class and Barthel Index,” noted the study authors. “In addition, it is important to assess some comorbidities and basic activities of daily living as well as the cognitive status of patients in the [emergency department], as they are also related to in-hospital and vulnerable post-discharge phase adverse outcomes in patients with de novo AHF.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Rizzi M A, Sarasola A G, Arbé A, et al. Factors associated with in‑hospital mortality and adverse outcomes during the vulnerable post‑discharge phase after the first episode of acute heart failure: results of the NOVICA‑2 study. [published online September 21, 2020] Clin Res Cardiol. doi:10.1007/s00392-020-01710-0