Clinical and prognostic implications of heart failure hospitalization in patients with advanced heart failure
Author:
Pagnesi Matteo1, Sammartino Antonio Maria1, Chiarito Mauro23, Stolfo Davide4, Baldetti Luca5, Adamo Marianna1, Maggi Giuseppe1, Inciardi Riccardo Maria1, Tomasoni Daniela1, Loiacono Ferdinando2, Maccallini Marta23, Villaschi Alessandro23, Gasparini Gaia23, Montella Marco23, Contessi Stefano4, Cocianni Daniele4, Perotto Maria4, Barone Giuseppe5, Merlo Marco4, Cappelletti Alberto Maria5, Sinagra Gianfranco4, Pini Daniela2, Metra Marco1, Lombardi Carlo Mario1
Affiliation:
1. Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia, Brescia 2. Humanitas Research Hospital IRCCS, Rozzano-Milan 3. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan 4. Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste 5. Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
Abstract
Background
Hospitalization is associated with poor outcomes in patients with heart failure, but its prognostic role in advanced heart failure is still unsettled. We evaluated the prognostic role of heart failure hospitalization in patients with advanced heart failure.
Methods
The multicenter HELP-HF registry enrolled consecutive patients with heart failure and at least one high-risk ‘I NEED HELP’ marker. Characteristics and outcomes were compared between patients who were hospitalized for decompensated heart failure (inpatients) or not (outpatients) at the time of enrolment. The primary endpoint was the composite of all-cause mortality or first heart failure hospitalization.
Results
Among the 1149 patients included [mean age 75.1 ± 11.5 years, 67.3% men, median left ventricular ejection fraction (LVEF) 35% (IQR 25–50%)], 777 (67.6%) were inpatients at the time of enrolment. As compared with outpatients, inpatients had lower LVEF, higher natriuretic peptides and a worse clinical profile. The 1-year rate of the primary endpoint was 50.9% in inpatients versus 36.8% in outpatients [crude hazard ratio 1.70, 95% confidence interval (CI) 1.39–2.07, P < 0.001]. At multivariable analysis, inpatient status was independently associated with a higher risk of the primary endpoint (adjusted hazard ratio 1.54, 95% CI 1.23–1.93, P < 0.001). Among inpatients, the independent predictors of the primary endpoint were older age, lower SBP, heart failure association criteria for advanced heart failure and glomerular filtration rate 30 ml/min/1.73 m2 or less.
Conclusion
Hospitalization for heart failure in patients with at least one high-risk ‘I NEED HELP’ marker is associated with an extremely poor prognosis supporting the need for specific interventions, such as mechanical circulatory support or heart transplantation.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine,General Medicine
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