Hospital readmissions and death from Heart Failure--rates still alarming.
BACKGROUND
Patients who require hospitalization because of decompensated HF represent a group of the most seriously ill individuals who evolve with high mortality and hospital readmission rates.


OBJECTIVE
We sought to evaluate the current natural course of HF by analyzing mortality and readmission rates in this new era of neurohormonal blockage.


METHODS
We followed the progress of 263 patients with a mean EF of 27.1%, admitted for decompensated HF between January 2005 and October 2006. Patients readmitted were only those whose health status precluded discharge after assessment and drug treatment in the Emergency Department. Patients were classified as HF-FC III/IV, mean age was 59.9+/-15.2 years, most were men, and 63.1% required inotropic drugs for cardiac compensation in the acute phase.


RESULTS
Average hospital stay was 25.1+/-16.7 days. During hospitalization, 23 (8.8%) patients died. After discharge, over an average follow-up period of 370 days, of the 240 patients who were discharged 123 (51.2%) returned to the Emergency Department 1 to 12 times (total number of visits: 350); 76 of them were readmitted, and the average length of readmission stay was 23.5+/-18.0 days. Over the first year of follow-up, 62 (25.8%) patients died.


CONCLUSIONS
HF remains a condition associated with high mortality and high hospital readmission rates. At the end of the first year, 44.5% of these patients had not needed to visit the ER or had died, which indicates that we should provide HF patients with the best possible care in an attempt to change the natural course of this increasingly frequent syndrome.
Barretto
Antonio Carlos Pereira
AC
Instituto do Coração, Hospital das Clinicas, FMUSP, São Paulo, SP, Brasil. pereira.barretto@incor.usp.br
Del Carlo
Carlos Henrique
CH
Cardoso
Juliano Novaes
JN
Morgado
Paulo Cesar
PC
Munhoz
Robson Tadeu
RT
Eid
Marcelo Ochiai
MO
Oliveira
Mucio Tavares
MT
Scipioni
Airton Roberto
AR
Ramires
Jose Antonio Franchini
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult