title: Influence of hospitalization for cardiovascular versus noncardiovascular reasons on subsequent mortality in patients with chronic heart failure across the spectrum of ejection fraction.
abstract: BACKGROUND
  Noncardiovascular (non-CV) comorbidities may contribute to hospitalizations in patients with heart failure (HF). We examined the incidence of mortality following hospitalization for cardiovascular (CV) versus non-CV reasons in the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program.
  
  
  RESULTS
  First hospitalizations for CV or non-CV reasons during the CHARM trial (N=7599) were related to subsequent risk of all-cause death using time-updated proportional hazards models. Over median 37.7 month follow-up, 2816 subjects (37.1%) were not hospitalized, 2893 (38.1%) were first hospitalized for CV reasons, and 1890 (24.9%) for non-CV reasons. The death rate (per 100 patient-years) among those not hospitalized was 2.8 compared with 17.8 after CV and 16.5 after non-CV hospitalization (both P<0.001 versus not hospitalized). Mortality at 30 days was higher after CV than non-CV hospitalization; however, among 30-day survivors of CV and non-CV hospitalization, rates of subsequent mortality were similar (14.5 versus 14.6 per 100 patient-years; P=0.62). Rates of CV hospitalization were higher for those with ejection fraction (EF) ≤40% than those with EF >40% (P<0.001), but rates of non-CV hospitalization did not vary by EF. Low EF patients had higher risk for mortality than preserved EF patients after any hospitalization, but within each EF subgroup, mortality in 30-day survivors of CV versus non-CV hospitalization was similar.
  
  
  CONCLUSIONS
  Non-CV hospitalization is frequent in patients with symptomatic heart failure and associated with risk of subsequent mortality similar to CV hospitalization across the spectrum of EF. These findings may have implications for developing strategies to prevent readmissions.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00634309 (CHARM-Added), NCT00634712 (CHARM-Preserved), NCT00634400 (CHARM-Alternative).
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.). adesai@partners.org.
authors.forename: Akshay S
authors.initials: AS
authors.lastname: Desai
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.).
authors.forename: Brian
authors.initials: B
authors.lastname: Claggett
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.).
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.).
authors.forename: Natalie
authors.initials: N
authors.lastname: Bello
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.).
authors.forename: Peter V
authors.initials: PV
authors.lastname: Finn
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.).
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.).
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.).
authors.forename: Stuart
authors.initials: S
authors.lastname: Pocock
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.).
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.).
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.affiliation: From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.).
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D013318:Stroke Volume
keywords: heart failure; hospitalization; mortality