title: Factors associated with prolonged hospitalization, readmission, and death in elderly heart failure patients in western Romania.
abstract: OBJECTIVE
  The purpose of this prospective study was to identify factors associated with prolonged hospitalization, readmission, and death in elderly patients presenting heart failure with reduced ejection fraction.
  
  
  METHODS
  All consecutive patients aged ≥65 years discharged with a diagnosis of acute new-onset heart failure and a left ventricular ejection fraction (LVEF) ≤45% were included and followed up for 1 year. The variables associated with outcomes were analyzed in univariate and multivariate logistic regression. For the independent predictors identified by multivariate analysis, receiver operating characteristic (ROC) analysis was performed.
  
  
  RESULTS
  A total of 71 patients were included in the study. The patient mean age was 72.5 years, 50% were female, and the mean LVEF was 31.25%±5.76%. In all, 34 (48%) patients experienced prolonged hospitalization, and this was independently associated with patients who were living in a rural area (P=0.005), those with a New York Heart Association functional class of 4 (P<0.001), the presence of comorbidities (P=0.023), chronic obstructive pulmonary disease (COPD) infectious exacerbation (P<0.001), and chronic kidney disease (P=0.025). In the multivariate analysis, only COPD infectious exacerbation was independently associated with prolonged hospitalization (P=0.003). A total 19 patients (27%) experienced readmissions during the 1-year follow up, of which 12 (17%) had cardiovascular causes and seven (10%) had noncardiovascular causes. The following independent variables associated with rehospitalizations were outlined in the univariate analysis: infections (P<0.020); COPD infectious exacerbation (P=0.015); one or more comorbidity (P<0.0001); and prolonged baseline hospitalization (P<0.0001). During the multivariate analysis, it was found that the independent predictors of readmissions were the presence of comorbidities (P<0.001) and prolonged baseline hospitalization (P<0.01). The 1-year mortality rate was 9.8%, with no significant difference between cardiovascular (5.6%) and noncardiovascular (4.2%) deaths. The only independent predictive variable for mortality was a New York Heart Association NYHA functional class 4 at baseline hospitalization (P=0.001).
  
  
  CONCLUSIONS
  Elderly patients are at high risk for prolonged hospitalization, readmission, and death following a first hospitalization for heart failure with reduced ejection fraction. The most powerful predictors for outcomes are the severity of heart failure, the presence of comorbidities, and prolonged hospitalization at baseline.
authors: University of Medicine and Pharmacy, Timisoara, Romania ; Cardiology Department, City Hospital, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
authors: Istvan
authors: I
authors: Gyalai-Korpos
authors: University of Medicine and Pharmacy, Timisoara, Romania ; Cardiology Department, City Hospital, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
authors: Oana
authors: O
authors: Ancusa
authors: University of Medicine and Pharmacy, Timisoara, Romania ; Cardiology Department, City Hospital, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
authors: Tiberiu
authors: T
authors: Dragomir
authors: University of Medicine and Pharmacy, Timisoara, Romania ; Cardiology Department, City Hospital, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
authors: Mirela Cleopatra
authors: MC
authors: Tomescu
authors: University of Medicine and Pharmacy, Timisoara, Romania ; Department of Epidemiology and Infectious Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
authors: Iosif
authors: I
authors: Marincu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012372:ROC Curve; D012383:Romania / Q000453:epidemiology; D013318:Stroke Volume
keywords: acute new onset heart failure; comorbidities; left ventricular ejection fraction; outcome predictors; reduced ejection fraction