title: Morbidity and Mortality of Congestive Heart Failure in Trauma Patients.
abstract: Cardiovascular morbidity and mortality in heart failure (HF) patients comprise a major health and economic burden, especially when readmission rate and length of stay (LOS) are considered. With increasing average life expectancy, HF prevalence continues to rise. Diseases such as diabetes mellitus, hypertension and ischemic heart disease continue to be the leading causes of HF. Current data suggest that HF is the most common cause for hospital admission in patients older than 65 years.
  
  
  
  In this study, we sought out to compare the 30-day readmission rate in trauma patients who have a preexisting history of HF to those who do not have a history of HF. Additionally, we emphasized the effect of different cardiac variables in the HF group such as the pathophysiology of HF (HF with preserved ejection fraction [HFpEF] versus HF with reduced ejection fraction [HFrEF]) and the etiology of HFrEF (ischemic versus nonischemic).
  
  
  
  A retrospective chart analysis of 8,137 patients who were admitted to our hospital between 2005 and 2013 secondary to trauma with an Injury Severity Score <30. Data were extracted using International Classification of Diseases, Ninth Revision codes. Neurotrauma patients were excluded.
  
  
  
  Of 8,137 trauma patients, 334 had preexisting HF, of which 169 had HFpEF while 165 had HFrEF). Of the 165 HFrEF cases, 121 were ischemic in etiology versus 44 nonischemic. Of 334 HF patients, 81 patients (24%) were readmitted within 30 days versus 1,068 (14%) of the non-HF patients (95% CI: 1.52-2.25, relative risk: 1.85, P < 0.0001). Of the 81 readmitted HF patients, 64 had HFpEF while 35 had HFrEF. There was no statistical significance observed in any of the endpoints in the HFpEF versus HFrEF groups. Mortality, 30-day readmission and LOS were all significantly higher in the ischemic versus nonischemic HFrEF group.
  
  
  
  In our trauma population, HF patients had a significantly higher 30-day readmission rate when compared to non-HF patients. The pathophysiology of HF (HFpEF versus HFrEF) did not seem to play a role. However, after subgroup analysis of the HFrEF group based on etiology, all endpoints including mortality, readmission and LOS were significantly higher in the ischemic HFrEF subgroup rendering this entity higher importance when treating trauma patients with preexisting HF.
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst, New York. Electronic address: hassan.alkhawam@mssm.edu.
authors.forename: Hassan
authors.initials: H
authors.lastname: Alkhawam
authors.affiliation: St. Francis Hospital-The Heart Center, Roslyn, New York.
authors.forename: Raef
authors.initials: R
authors.lastname: Madanieh
authors.affiliation: Present Saint Joseph Hospital, Chicago, Illinois.
authors.forename: Mohammed
authors.initials: M
authors.lastname: El-Hunjul
authors.affiliation: St. Francis Hospital-The Heart Center, Roslyn, New York.
authors.forename: Abed
authors.initials: A
authors.lastname: Madanieh
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst, New York.
authors.forename: Umer
authors.initials: U
authors.lastname: Syed
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst, New York.
authors.forename: Sumair
authors.initials: S
authors.lastname: Ahmad
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst, New York.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Lieber
authors.affiliation: St. Francis Hospital-The Heart Center, Roslyn, New York.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Vittorio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality / Q000639:trends; D010359:Patient Readmission / Q000639:trends*; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000401:mortality*
keywords: HFpEF; HFrEF; Heart failure; Trauma