Bhosale Kakasaheb H, Nath Ranjit Kumar, Pandit Neeraj, Agarwal Puneet, Khairnar Shripad, Yadav Balram, Chandrakar Sulabh
Department of Cardiology, ABVIMS & Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Int J Heart Fail. 2020 Apr 21;2(2):131-144. doi: 10.36628/ijhf.2020.0007. eCollection 2020 Apr.
Identifying the patients with acute heart failure (HF) at high risk for rehospitalization after hospital discharge will enable proper optimization of treatment. This study is aimed to evaluate the rehospitalization rate at 60 days of discharge and their predictors in patients of chronic heart failure with reduced ejection fraction (HFrEF).
This prospective observational study enrolled patients with left ventricle ejection fraction (LVEF) <40%, who were admitted because of acute decompensation. Patients were followed for 60 days to analyze rehospitalization rate and its predictors.
Of 103 HFrEF patients (74% male; mean age 55.8 years) enrolled, 7 patients died during index admission and 3 patients lost to follow up. The 60-day rehospitalization rate was 37% (34/93). We studied 23 clinical and 9 biochemical predictors of rehospitalization. Out of 34 events of rehospitalization, 79.41% (n=28) was due to cardiac cause followed by respiratory 5.8% (n=2), renal 5.8% (n=2) and others 5.8% (n=2). Among all the parameters, on logistic regression analysis having longer length of index hospital stay (>7 days) (52.8% vs. 28.8%; odds ratio [OR], 1.79; confidence interval [CI], 1.2-7.25; p=0.040) and chronic kidney disease (CKD) (26.5% vs. 8.5%; OR, 3.06; CI, 1.1-57.04; p=0.050) independently increased the risk of rehospitalization at 60 days of discharge. Further higher haemoglobin level (11.3 vs. 9.9 gm/dL; OR, 0.71; CI, 0.48-0.97; p=0.050) and higher LVEF at index admission (30.4% vs. 26.5%; OR, 0.87; CI, 0.75-0.99; p=0.049) were associated with decreased the risk of rehospitalization.
Our study reveals that patients with HFrEF have significantly higher rehospitalization rate (37%) and in-hospital mortality rates (6.78%) of any chronic cardiac disease conditions. Correction of low hemoglobin and special care in those who are having very low LVEF, CKD and longer length of stay, including tailored therapy and frequent visits may play an important role in preventing future rehospitalization in these patients.
识别出院后再住院风险高的急性心力衰竭（HF）患者，有助于合理优化治疗方案。本研究旨在评估射血分数降低的慢性心力衰竭（HFrEF）患者出院60天时的再住院率及其预测因素。
这项前瞻性观察性研究纳入了左心室射血分数（LVEF）<40%、因急性失代偿而入院的患者。对患者进行60天的随访，以分析再住院率及其预测因素。
纳入的103例HFrEF患者（74%为男性；平均年龄55.8岁）中，7例在首次住院期间死亡，3例失访。60天再住院率为37%（34/93）。我们研究了23项临床和9项生化再住院预测因素。在34例再住院事件中，79.41%（n = 28）是由心脏原因导致的，其次是呼吸原因5.8%（n = 2）、肾脏原因5.8%（n = 2）和其他原因5.8%（n = 2）。在所有参数中，经逻辑回归分析，首次住院时间较长（>7天）（52.8%对28.8%；比值比[OR]，1.79；置信区间[CI]，1.2 - 7.25；p = 0.040）和慢性肾脏病（CKD）（26.5%对8.5%；OR，3.06；CI，1.1 - 57.04；p = 0.050）独立增加出院60天时再住院的风险。此外，血红蛋白水平较高（11.3对9.9 g/dL；OR，0.71；CI，0.48 - 0.97；p = 0.050）和首次入院时LVEF较高（30.4%对26.5%；OR，0.87；CI，0.75 - 0.99；p = 0.049）与再住院风险降低相关。
我们的研究表明，HFrEF患者的再住院率（37%）和住院死亡率（6.78%）显著高于任何慢性心脏病情况。纠正低血红蛋白水平，并对LVEF极低、患有CKD和住院时间较长的患者给予特别护理，包括量身定制的治疗和频繁随访，可能对预防这些患者未来的再住院起到重要作用。
