title: Causes and predictors of hospital readmissions in patients older than 65 years hospitalized for heart failure with preserved left ventricular ejection fraction in western Romania.
abstract: BACKGROUND
  Heart failure with preserved ejection fraction (HFpEF) is more frequent in the elderly and is associated with important economic implications because of repetitive and prolonged hospitalizations, due to both cardiovascular and noncardiovascular causes.
  
  
  OBJECTIVE
  To identify the causes, as well as the clinical and biological markers, that could be used as predictors of hospital readmissions in HFpEF patients aged ≥65 years.
  
  
  METHODS
  Consecutive eligible patients hospitalized for a first heart failure (HF) episode were prospectively included and divided into one of two age groups (elderly: ≥65 years; and nonelderly: <65 years). The clinical features, therapeutic approaches, and clinical outcomes during the 1-year follow-up period were analyzed.
  
  
  RESULTS
  A total of 178 patients were included, with a mean age of 64.6±8.6 years; 80 (45%) were women. A total of 98 patients (55%) were aged ≥65 years, and 80 (45%) were aged <65 years. In the group aged ≥65 years, 58 patients (59%) were women, while in the group aged <65 years, 22 patients (28%) were women (P=0.0001). During the 1-year follow-up, no patients died or were lost to follow-up. Moreover, 116 (65%) of the HFpEF patients experienced hospital readmissions. The elderly patients had a significantly higher readmission rate (73% vs 55%, respectively; P<0.02); readmissions due to aggravated HF were significantly more frequent in this age group (41% vs 18%, respectively; P<0.002). Multivariate logistic regression analysis indicated that the independent predictors of readmission due to HF aggravation included plasma levels of brain natriuretic peptide >450 pg/mL (P<0.01) and N-terminal-pro-brain natriuretic peptide >477 pg/mL (P<0.02) in the elderly group, while in the nonelderly group, the independent predictors of this outcome were a New York Heart Association functional class of IV at initial hospitalization (P<0.04), as well as plasma levels of brain natriuretic peptide >390 pg/mL (P=0.03) and tumor necrosis factor (TNF)-α >7.1 pg/mL (P<0.001). Readmissions due to noncardiovascular causes were independently predicted by plasma levels of TNF-α >10 pg/mL in the elderly (P=0.003) and of interleukin (IL)-6 >1.9 pg/mL in the nonelderly (P<0.04).
  
  
  CONCLUSIONS
  We conclude that in HFpEF patients aged ≥65 years, the main cause of rehospitalization during the 1-year follow-up was HF aggravation. The risk of this outcome was independently predicted by increased levels of cardiac peptides, while the risk of noncardiovascular readmissions was predicted by increased levels of inflammatory biomarkers. Increased TNF-α levels predicted both cardiovascular and noncardiovascular readmissions, while increased levels of high-sensitivity C-reactive protein did not predict any of these outcomes in our study.
authors.affiliation: Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
authors.forename: Adelina Marioara
authors.initials: AM
authors.lastname: Mavrea
authors.affiliation: Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
authors.forename: Tiberiu
authors.initials: T
authors.lastname: Dragomir
authors.affiliation: Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
authors.forename: Diana Aurora
authors.initials: DA
authors.lastname: Bordejevic
authors.affiliation: Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
authors.forename: Mirela Cleopatra
authors.initials: MC
authors.lastname: Tomescu
authors.affiliation: Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
authors.forename: Oana
authors.initials: O
authors.lastname: Ancusa
authors.affiliation: Department of Epidemiology and Infectious Diseases, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
authors.forename: Iosif
authors.initials: I
authors.lastname: Marincu
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000503:physiopathology*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D012383:Romania; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D014409:Tumor Necrosis Factor-alpha; D020097:Natriuretic Peptide, Brain
keywords: elderly; heart failure with preserved left ventricular ejection fraction; hospital readmissions