title: Magnitude of and Prognostic Factors Associated With 1-Year Mortality After Hospital Discharge for Acute Decompensated Heart Failure Based on Ejection Fraction Findings.
abstract: BACKGROUND
  Limited data exist about the magnitude of and the factors associated with prognosis within 1 year for patients discharged from the hospital after acute decompensated heart failure. Data are particularly limited from the more generalizable perspective of a population-based investigation and should be further stratified according to currently recommended ejection fraction (EF) findings.
  
  
  RESULTS
  The hospital medical records of residents of the Worcester, Massachusetts, metropolitan area who were discharged after acute decompensated heart failure from all 11 medical centers in central Massachusetts during 1995, 2000, 2002, 2004, and 2006 were reviewed. The average age of the 4025 study patients was 75 years, 93% were white, and 44% were men. Of these, 35% (n=1414) had reduced EF (≤40%), 13% (n=521) had borderline preserved EF (41-49%), and 52% (n=2090) had preserved EF (≥50%); at 1 year after discharge, death rates were 34%, 30%, and 29%, respectively (P=0.03). Older age, a history of chronic obstructive pulmonary disease, systolic blood pressure findings <150 mm Hg on admission, and hyponatremia were important predictors of 1-year mortality for all study patients, whereas several comorbidities and physiological factors were differentially associated with 1-year death rates in patients with reduced, borderline preserved, and preserved EF.
  
  
  CONCLUSIONS
  This population-based study highlights the need for further contemporary research into the characteristics, treatment practices, natural history, and long-term outcomes of patients with acute decompensated heart failure and varying EF findings and reinforces ongoing discussions about whether different treatment guidelines may be needed for these patients to design more personalized treatment plans.
authors.affiliation: Program in Gene Function and Expression, University of Massachusetts Medical School, Worcester, MA (A.H.C.).
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Coles
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.T., J.Y., D.L., R.J.G.).
authors.forename: Mayra
authors.initials: M
authors.lastname: Tisminetzky
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.T., J.Y., D.L., R.J.G.).
authors.forename: Jorge
authors.initials: J
authors.lastname: Yarzebski
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.T., J.Y., D.L., R.J.G.).
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA (J.M.G.).
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.affiliation: Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA (C.E.D.).
authors.forename: Chad E
authors.initials: CE
authors.lastname: Darling
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.T., J.Y., D.L., R.J.G.).
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
mesh_terms: D000208:Acute Disease; D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology
chemical_list: D002316:Cardiotonic Agents
keywords: acute heart failure; ejection fraction findings; population‐based study