Burden of Recurrent Hospitalizations Following an Admission for Acute Heart Failure: Preserved Versus Reduced Ejection Fraction.
OBJECTIVE
Heart failure with preserved ejection fraction and reduced ejection fraction share a high mortality risk. However, differences in the rehospitalization burden over time between these 2 entities remains unclear.


METHODS
We prospectively included 2013 consecutive patients discharged for acute heart failure. Of these, 1082 (53.7%) had heart failure with preserved ejection fraction and 931 (46.2%) had heart failure with reduced ejection fraction. Cox and negative binomial regression methods were used to evaluate the risks of death and repeat hospitalizations, respectively.


RESULTS
At a median follow-up of 2.36 years (interquartile range: 0.96-4.65), 1018 patients (50.6%) died, and 3804 readmissions were registered in 1406 patients (69.8%). Overall, there were no differences in mortality between heart failure with preserved ejection fraction and heart failure with reduced ejection fraction (16.7 vs 16.1 per 100 person-years, respectively; P=0794), or all-cause repeat hospitalization rates (62.1 vs 62.2 per 100 person-years, respectively; P=.944). After multivariable adjustment, and compared with patients with heart failure with reduced ejection fraction, patients with heart failure with preserved ejection fraction exhibited a similar risk of all-cause readmissions (incidence rate ratio=1.04; 95%CI, 0.93-1.17; P=.461). Regarding specific causes, heart failure with preserved ejection fraction showed similar risks of cardiovascular and heart failure-related rehospitalizations (incidence rate ratio=0.93; 95%CI, 0.82-1.06; P=.304; incidence rate ratio=0.96; 95% confidence interval, 0.83-1.13; P=.677, respectively), but had a higher risk of noncardiovascular readmissions (incidence rate ratio=1.24; 95%CI, 1.04-1.47; P=.012).


CONCLUSIONS
Following an admission for acute heart failure, patients with heart failure with preserved ejection fraction have a similar rehospitalization burden to those with heart failure with reduced ejection fraction. However, patients with heart failure with preserved ejection fraction are more likely to be readmitted for noncardiovascular causes.
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain.
Enrique
E
Santas
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain.
Ernesto
E
Valero
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain.
Anna
A
Mollar
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain.
Sergio
S
García-Blas
Servicio de Cardiología, Hospital La Plana, Universitat Jaume I, Castellón, Spain.
Patricia
P
Palau
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain.
Gema
G
Miñana
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain.
Eduardo
E
Núñez
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain.
Juan
J
Sanchis
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain.
Francisco Javier
FJ
Chorro
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain. Electronic address: yulnunez@gmail.com.
Julio
J
Núñez
D000208:Acute Disease; D000368:Aged; D017281:Cost of Illness; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010359:Patient Readmission; D012008:Recurrence; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy
Heart failure; Hospitalizaciones; Hospitalizations; Insuficiencia cardiaca; Prognosis; Pronóstico