PURPOSE: Little is known about natural corse, reasons and predictors for hospitalisations.after heart failure(HF) diagnosis.
METHODS: We assessed frequecy,causes and predictors of hospitalisations after HF diagnosis.In detemining predictors of hospitalisations,we used the data at death or last follow-up.
RESULTS: Among 144 patients after HF diagnosis, 164 hospitalisations occurred in 82 patients(aged 76.9(SD 9.7), female 42.9%, mean follow-up 4.2(SD2.2) years, 340.1 patients-years).Forty five(54.9%) patients had died. Hospitalisations ranged 0-7 times(median 2) per patient. Thirty seven(45.3%) patients had one hospitalisation, 23(28.0%),14(17.4%),8(10.0%) had ≧2,≧3,≧4,respectively. The mean rate of hospitalisation was 50.2/100 patient-years. Half of patients were hospitalised once for each year or HF patients were hospitalised once every two years. The reasons for hospitalisations were due to HF,other cardiovascular and noncardiovascular, HF: 55(32.5%) in 22 patients,other cardiovascular:24(16.4%)in 15, noncardiovascular:85(51.8%) in 45.HF hospitalisations were in only 1/3 of total hospitalisations.Half of hospitalisations were due to noncardiovascular hospitalisation. Reasons for other cardiovascular hospitalisations were arrhyhtmias 15(62.1%) in 13,ischemia 8(33.3%)2. Reasons for noncardiovascular hospitalisations included chronic lung diseases,pneumonia,malignancy,prior myocardial infarction(MI),cerebrovascular,musculoskeletal,liver and gallbladder,gastrointestinal tract disorders accounted for 55.5%. Other comorbidities caused additional reasons for hospitalisations. HF hospitalisations ranged 1-4 times per patient. Ten patients had one hospitalisation, 7 had 2 and 5 had three and more. The 55.9% hospitalisations clustered among 6 of 24 patients. Patients with ejection fracction< 50%(EF< 50) and estimated glomerulofiltration ratio< 30 ml/min/1.73m2(e-GFR< 30) were more often hospitalised.(p=0.001,p=0.002,respectively). Death occurred in 45(54.9%)(age 74.6(SD 4.2),female(36.1%)). Reasons for death were like in those for hospitalisations, HF:14 patients(33.3%),other cardiovascular: 8(19.0%),noncardiovascular: 22(48.9%). In univariate analysis,male,age,chronic lung disease,pneumonia, cerebrovascular disorders,malignancy,EF< 50,e-GFR< 30,prior MI were associated with an increased rik of hospitalisations(p< 0.05). In multivariate analysis,e-GFR(p=0.001,odds ratio(OR) 1.513(95% confidence index interval(CI) 1.001~2.288),EF< 50(p=0.001,OR 2.054(95% CI 1.326~3.182),cerebrovasculardisease(p=0.01, OR 1.039(95% CI 1.015~1.604), chronic lung disease(p=0.003, OR 3.718(95% CI 2.545~5.431) were independent factors in hospitalisations.
CONCLUSION: Multiple hospitalisations are common in patients after HF diagnosis. Half of hospitalisations were due to noncardiovascular problems with comorbidities in the elderly.
CLINICAL IMPLICATIONS: The early interventions in comorbidities could reduce further hospitalisations in the eldrly HF patients.
DISCLOSURE: Nobuyuki Anzai, No Financial Disclosure Information; No Product/Research Disclosure Information