Predicting readmissions and cardiovascular events in heart failure patients.
OBJECTIVE
To analyse measures of clinical data, functional capacity, left ventricular function and neurohormonal activation for the ability to predict mortality and morbidity in patients after a hospitalisation for heart failure.


METHODS
In a prospective study, patients 60 years or above with systolic heart failure NYHA II-IV were followed for at least 18 months. At study start, a physical examination, echocardiography, blood samples and measurements of quality of life (QoL) by Nottingham Health Profile were obtained. Data on mortality and readmission rates were collected.


RESULTS
208 patients, 58% men, with a mean age of 76 years, and an ejection fraction of 0.34 were included and followed for a mean of 1,122 days. In all, 74 (36%) patients died and 171 (82%) were readmitted. By univariate analysis, readmissions were predicted by poor QoL (169 +/- 118 vs. 83 +/- 100, p < 0.001), age, creatinine, haemoglobin (p < 0.01 all) and diabetes (p < 0.1). By multivariate analyses, QoL at study start was the only independent predictor of readmissions (chi(2) = 25.2, p < 0. 001). Mortality was univariately associated with QoL (183 +/- 117 vs. 142 +/- 115, p < 0.05) and in multivariate analyses to traditional variables: age, male gender, systolic function, BNP and serum creatinine (chi(2) = 48.9, p < 0.001).


CONCLUSIONS
Measurements representing different aspects of the heart failure syndrome can easily be obtained to stratify long-term risks of mortality and morbidity in hospitalised heart failure patients. Poor QoL was a univariate predictor for mortality and a strong multivariate predictor for the important outcome of readmission, pointing to the need for a simple assessment of QoL.
Mejhert
M
M
Karolinska Institutet Danderyd Hospital, Division of Internal Medicine, Stockholm, Sweden. marit.mejhert@ersta.se
Kahan
T
T
Persson
H
H
Edner
M
M
D000368:Aged; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018377:Neurotransmitter Agents / Q000097:blood; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D011788:Quality of Life; D018570:Risk Assessment; D014463:Ultrasonography; D016277:Ventricular Function, Left
D018377:Neurotransmitter Agents