title: Nonalcoholic fatty liver disease and increased risk of 1-year all-cause and cardiac hospital readmissions in elderly patients admitted for acute heart failure.
abstract: Nonalcoholic fatty liver disease (NAFLD) is an emerging risk factor for heart failure (HF). Although some progress has been made in improving survival among patients admitted for HF, the rates of hospital readmissions and the related costs continue to rise dramatically. We sought to examine whether NAFLD and its severity (diagnosed at hospital admission) was independently associated with a higher risk of 1-year all-cause and cardiac re-hospitalization in patients admitted for acute HF. We studied 212 elderly patients who were consecutively admitted with acute HF to the Hospital of Negrar (Verona) over a 1-year period. Diagnosis of NAFLD was based on ultrasonography, whereas the severity of advanced NAFLD fibrosis was based on the fibrosis (FIB)-4 score and other non-invasive fibrosis scores. Patients with acute myocardial infarction, severe valvular heart diseases, end-stage renal disease, cancer, known liver diseases or decompensated cirrhosis were excluded. Cox regression was used to estimate hazard ratios (HR) for the associations between NAFLD and the outcome(s) of interest. The cumulative rate of 1-year all-cause re-hospitalizations was 46.7% (n = 99, mainly due to cardiac causes). Patients with NAFLD (n = 109; 51.4%) had remarkably higher 1-year all-cause and cardiac re-hospitalization rates compared with their counterparts without NAFLD. Both event rates were particularly increased in those with advanced NAFLD fibrosis. NAFLD was associated with a 5-fold increased risk of 1-year all-cause re-hospitalization (adjusted-hazard ratio 5.05, 95% confidence intervals 2.78-9.10, p<0.0001) after adjustment for established risk factors and potential confounders. Similar results were found for 1-year cardiac re-hospitalization (adjusted-hazard ratio 8.05, 95% confidence intervals 3.77-15.8, p<0.0001). In conclusion, NAFLD and its severity were strongly and independently associated with an increased risk of 1-year all-cause and cardiac re-hospitalization in elderly patients admitted with acute HF.
authors.affiliation: Division of General Medicine "Sacro Cuore" Hospital, Negrar, Verona, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Valbusa
authors.affiliation: Division of Cardiology, "Sacro Cuore" Hospital, Negrar, Verona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonapace
authors.affiliation: Division of General Medicine "Sacro Cuore" Hospital, Negrar, Verona, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Agnoletti
authors.affiliation: Division of General Medicine "Sacro Cuore" Hospital, Negrar, Verona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Scala
authors.affiliation: Division of General Medicine "Sacro Cuore" Hospital, Negrar, Verona, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Grillo
authors.affiliation: Division of Geriatrics, "Sacro Cuore" Hospital, Negrar, Verona, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Arduini
authors.affiliation: Division of Geriatrics, "Sacro Cuore" Hospital, Negrar, Verona, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Turcato
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mantovani
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zoppini
authors.affiliation: Division of General Medicine "Sacro Cuore" Hospital, Negrar, Verona, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Arcaro
authors.affiliation: Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.|Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Byrne
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Targher
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D010359:Patient Readmission; D012307:Risk Factors