Elke Platz1, Pardeep S Jhund2, Brian L Claggett3, Marc A Pfeffer3, Karl Swedberg4,5, Christopher B Granger6, Salim Yusuf7, Scott D Solomon3, John J McMurray2. 1. Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 2. British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. 3. Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 4. Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden. 5. National Heart and Lung Institute, Imperial College London, London, UK. 6. Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA. 7. Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.
Abstract
AIMS: Hospitalizations for heart failure (HF) are common and are associated with significant morbidity, mortality and cost. However, precipitating factors leading to HF hospitalization and their importance with respect to subsequent outcomes are not well understood. METHODS AND RESULTS: The symptoms and signs present at admission and investigator-identified factors thought to have contributed to the first adjudicated HF hospitalization in the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) programme were prospectively collected and stratified by ejection fraction (EF). Potential precipitants were collected using a specifically designed case report form and categorized according to the presence of cardiovascular (CV), non-CV and unknown factors. Associations between these factors and subsequent rehospitalization and mortality rates were examined. Of 1668 patients who experienced HF hospitalization, 1152 had reduced EF (≤40%, HFrEF) and 516 had preserved EF (HFpEF). Overall, 54% had CV, 32% had non-CV and 14% had unknown factors thought to have precipitated HF, with similar proportions in the HFrEF and HFpEF groups. The most common precipitants were arrhythmia (15%), other non-CV factors (11%) and respiratory infection (10%). Subsequent CV readmission rates were highest in those whose initial HF hospitalization was precipitated by CV factors. However, mortality rates were similar among patients with any of the three categories of precipitating factors. Results were similar in HFrEF and HFpEF. CONCLUSIONS: Among chronic HF patients hospitalized for decompensation, the investigator-reported precipitating factor was not associated with the subsequent mortality rate, but was associated with type of readmission: readmissions for CV reasons were more likely when the index precipitant was CV.
RCT Entities:
AIMS: Hospitalizations for heart failure (HF) are common and are associated with significant morbidity, mortality and cost. However, precipitating factors leading to HF hospitalization and their importance with respect to subsequent outcomes are not well understood. METHODS AND RESULTS: The symptoms and signs present at admission and investigator-identified factors thought to have contributed to the first adjudicated HF hospitalization in the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) programme were prospectively collected and stratified by ejection fraction (EF). Potential precipitants were collected using a specifically designed case report form and categorized according to the presence of cardiovascular (CV), non-CV and unknown factors. Associations between these factors and subsequent rehospitalization and mortality rates were examined. Of 1668 patients who experienced HF hospitalization, 1152 had reduced EF (≤40%, HFrEF) and 516 had preserved EF (HFpEF). Overall, 54% had CV, 32% had non-CV and 14% had unknown factors thought to have precipitated HF, with similar proportions in the HFrEF and HFpEF groups. The most common precipitants were arrhythmia (15%), other non-CV factors (11%) and respiratory infection (10%). Subsequent CV readmission rates were highest in those whose initial HF hospitalization was precipitated by CV factors. However, mortality rates were similar among patients with any of the three categories of precipitating factors. Results were similar in HFrEF and HFpEF. CONCLUSIONS: Among chronic HF patients hospitalized for decompensation, the investigator-reported precipitating factor was not associated with the subsequent mortality rate, but was associated with type of readmission: readmissions for CV reasons were more likely when the index precipitant was CV.
Authors: R T Tsuyuki; R S McKelvie; J M Arnold; A C Barretto; A C Carvalho; D L Isaac; A D Kitching; L S Piegas; K K Teo; S Yusuf Journal: Arch Intern Med Date: 2001-10-22
Authors: Marc A Pfeffer; Karl Swedberg; Christopher B Granger; Peter Held; John J V McMurray; Eric L Michelson; Bertil Olofsson; Jan Ostergren; Salim Yusuf; Stuart Pocock Journal: Lancet Date: 2003-09-06 Impact factor: 79.321
Authors: John R Kapoor; Roger Kapoor; Christine Ju; Paul A Heidenreich; Zubin J Eapen; Adrian F Hernandez; Javed Butler; Clyde W Yancy; Gregg C Fonarow Journal: JACC Heart Fail Date: 2016-06 Impact factor: 12.035
Authors: Putte Abrahamsson; Karl Swedberg; Jeffrey S Borer; Michael Böhm; Lars Kober; Michel Komajda; Suzanne M Lloyd; Marco Metra; Luigi Tavazzi; Ian Ford Journal: Eur J Heart Fail Date: 2013-03-03 Impact factor: 15.534
Authors: Jennifer K Rogers; Stuart J Pocock; John J V McMurray; Christopher B Granger; Eric L Michelson; Jan Östergren; Marc A Pfeffer; Scott D Solomon; Karl Swedberg; Salim Yusuf Journal: Eur J Heart Fail Date: 2013-12-18 Impact factor: 15.534
Authors: Piotr Ponikowski; Adriaan A Voors; Stefan D Anker; Héctor Bueno; John G F Cleland; Andrew J S Coats; Volkmar Falk; José Ramón González-Juanatey; Veli-Pekka Harjola; Ewa A Jankowska; Mariell Jessup; Cecilia Linde; Petros Nihoyannopoulos; John T Parissis; Burkert Pieske; Jillian P Riley; Giuseppe M C Rosano; Luis M Ruilope; Frank Ruschitzka; Frans H Rutten; Peter van der Meer Journal: Eur Heart J Date: 2016-05-20 Impact factor: 29.983
Authors: Ravi B Patel; Muthiah Vaduganathan; Aruna Rikhi; Hrishikesh Chakraborty; Stephen J Greene; Adrian F Hernandez; G Michael Felker; Margaret M Redfield; Javed Butler; Sanjiv J Shah Journal: JACC Heart Fail Date: 2018-11-05 Impact factor: 12.035
Authors: Jasper Tromp; Joost C Beusekamp; Wouter Ouwerkerk; Peter van der Meer; John G F Cleland; Christiane E Angermann; Ulf Dahlstrom; Georg Ertl; Mahmoud Hassanein; Sergio V Perrone; Mathieu Ghadanfar; Anja Schweizer; Achim Obergfell; Gerasimos Filippatos; Kenneth Dickstein; Sean P Collins; Carolyn S P Lam Journal: Eur J Heart Fail Date: 2022-02-17 Impact factor: 17.349
Authors: Annika M Jödicke; Andrea M Burden; Urs Zellweger; Ivan T Tomka; Thomas Neuer; Malgorzata Roos; Gerd A Kullak-Ublick; Ivanka Curkovic; Marco Egbring Journal: Eur J Clin Pharmacol Date: 2020-04-08 Impact factor: 2.953
Authors: David M Kaye; Mark C Petrie; Scott McKenzie; Gerd Hasenfuβ; Filip Malek; Martijn Post; Robert N Doughty; Jean-Noël Trochu; Finn Gustafsson; Irene Lang; Adam Kolodziej; Ralf Westenfeld; Martin Penicka; Mark Rosenberg; Jörg Hausleiter; Philip Raake; Guillaume Jondeau; Martin W Bergmann; Tim Spelman; Huseyin Aytug; Piotr Ponikowski; Chris Hayward Journal: ESC Heart Fail Date: 2018-10-11