Critical elements of clinical follow-up after hospital discharge for heart failure: insights from the EVEREST trial.
OBJECTIVE
Hospitalized heart failure (HF) patients are at high risk for death and readmission. We examined the incremental value of data obtained 1 week after HF hospital discharge in predicting mortality and readmission.


RESULTS
In the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with tolvaptan, 1528 hospitalized patients (ejection fraction < or =40%) with a physical examination, laboratories, and health status [Kansas City Cardiomyopathy Questionnaire (KCCQ)] assessments 1 week after discharge were included. The ability to predict 1 year cardiovascular rehospitalization and mortality was assessed with Cox models, c-statistics, and the integrated discrimination improvement (IDI). Not using a beta-blocker, rales, pedal oedema, hyponatraemia, lower creatinine clearance, higher brain natriuretic peptide, and worse health status were independent risk factors for rehospitalization and death. The c-statistic for the base model (history and medications) was 0.657. The model improved with physical examination, laboratory, and KCCQ results, with IDI increases of 4.9, 7.0, and 3.2%, respectively (P < 0.001 each). The combination of all three offered the greatest incremental gain (c-statistic 0.749; IDI increase 10.8%).


CONCLUSIONS
Physical examination, laboratories, and KCCQ assessed 1 week after discharge offer important prognostic information, suggesting that all are critical components of outpatient evaluation after HF hospitalization.
Dunlay
Shannon M
SM
Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA.
Gheorghiade
Mihai
M
Reid
Kimberly J
KJ
Allen
Larry A
LA
Chan
Paul S
PS
Hauptman
Paul J
PJ
Zannad
Faiez
F
Maggioni
Aldo P
AP
Swedberg
Karl
K
Konstam
Marvin A
MA
Spertus
John A
JA
D000368:Aged; D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines / Q000627:therapeutic use*; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D000077602:Tolvaptan; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D000077602:Tolvaptan