Characterization of acute heart failure hospitalizations in a Portuguese Cardiology Department

• Type: Summary of Presentation in an International Conference
• Date: 2012

Authors

Gomes AC (Author) Other; Silva Cardoso J (Author) Other; Azevedo L (Author) Other; Almeida R (Author) Other; Pinho T (Author) Other; Maciel MJ (Author) FMUP

Conference proceedings International

Title: European Journal of Heart Failure Supplements

Initial page: P1003

Heart Failure Congress 2012

Belgrade, 2012

Scientific classification

FOS: Medical and Health sciences > Clinical medicine

Other information

Abstract (EN): Purpose: We describe the clinical characteristics, hospital management and outcomes of patients (pts) hospitalized with Acute Heart Failure (AHF) in a Portuguese CardiologyDepartment. We sought to identify factors associated with increased length ofstay (LOS), long-term re-hospitalization due to HF or death. Methods: In this retrospective cohort study we reviewed the medical records of all pts admitted to our Cardiology Department during 2010. We selected those with either a primary diagnosis of AHF or with AHF secondary to another acute cardiac event. The occurrence of death and readmission due to HF were followed through 2011 (mean follow-up time of 18 months). Results: From the total of 924 pts admitted during one year, 201 (22%) presented AHF. Mean age of AHF pts was 69±13 and 61% were male. The main precipitating factor was ACS (63%), followed by arrhythmia (14%). De novo AHF was more common (53%), than decompensation of Chronic HF (47%). Fifteen percent had an AHF hospitalization in the previous year. The most common clinical presentations were HF in the context of ACS (63%) followed by decompensate CHF (47%) and acute pulmonary edema (21%). Hypertension (66%) and dyslipidemia (51%) were the most frequent comorbidities. On admission 73% of pts had Left Ventricular Ejection Fraction (LVEF)<0.50. Target doses of renin-angiotensin-aldosterone system blockers and of β-blockers were achieved only in a minority of pts. Median LOS was 11 [P25 -- P75: 7 -- 16] days and in-hospital mortality rate was 5.5%.Re-hospitalization rate due HF was 21% at six months and 24% at 12 months. Most re-hospitalizations (52%) occurred during the first six weeks after discharge. All-cause mortality was 16% at 12 months. The independent variables associated with an increased LOS were HF hospitalization during the previous year (p=0.040), BNP > 500 pg/ml (p<0.001) and Intensive Care Unit admission (p=0.002). In a predictive multivariate Cox regression model for the composite outcome of re-hospitalization or death, the most important variables were HF hospitalization during the previous year (HR 3.177 [95% CI 1.405 --7.185]), serum sodium < 135 mEq/L on admission (HR 1.995 [95% CI 1.032 --3.856]), atrial fibrillation (HR 1.791 [95% CI 1.021 -- 3.142]) and depressed LVEF (HR 0.518 [95% CI 0.268 -- 0.998]). Conclusions: Pts admitted to our Cardiology Department typically presented new-onset AHF, due to an ACS, causing depressed LVEF. Several predictive factors of death or re-hospitalization emerged from our analysis that can help identifying high-risk pts to be followed in a HF management program after discharge.

Language: English

Type (Professor's evaluation): Scientific

Notes: Gomes AC, Silva Cardoso J, Azevedo L, Almeida R, Pinho T, Maciel MJ. Characterization of acute heart failure hospitalizations in a Portuguese Cardiology Department. Eur J Heart Fail Suppl 2012; 11(Suppl 1): P1003. ISSN 1567-4215. Heart Failure Congress 2012, Belgrade, 2012