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The vulnerable phase after hospitalization for heart failure.

Publication ,  Journal Article
Greene, SJ; Fonarow, GC; Vaduganathan, M; Khan, SS; Butler, J; Gheorghiade, M
Published in: Nat Rev Cardiol
April 2015

Despite available therapy, mortality and readmission rates within 60-90 days of discharge for patients hospitalized with heart failure (HF) approach 15% and 30%, respectively. This early postdischarge period has been termed the 'vulnerable phase' and accounts for a disproportionate amount of the >US$30 billion spent annually on HF care in the USA. The pathophysiology underlying these early adverse events is likely associated with persistently elevated filling pressures at time of discharge and subsequent acute or subacute worsening of postdischarge haemodynamics. Despite limited proven strategies to reduce early adverse events, hospitals in the USA face penalties for 30-day readmission rates that exceed current expectations, and an urgent need exists for novel approaches to improve early postdischarge outcomes. The objective of this Review is to describe the early postdischarge problem among patients hospitalized for HF, the associated patient profile and pathophysiology, and the limitations of current postdischarge treatment strategies. We also identify therapeutic targets and outline a progressive management approach that should be considered by clinicians for reducing early postdischarge morbidity and mortality. Although these strategies require prospective validation, they are practical, affordable, and have the potential to improve patient outcomes substantially after HF hospitalization.

Duke Scholars

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Published In

Nat Rev Cardiol

DOI

EISSN

1759-5010

Publication Date

April 2015

Volume

12

Issue

4

Start / End Page

220 / 229

Location

England

Related Subject Headings

  • Prognosis
  • Patient Readmission
  • Patient Discharge
  • Humans
  • Hospitalization
  • Heart Failure
  • Disease Management
  • Comorbidity
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
 

Citation

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Greene, S. J., Fonarow, G. C., Vaduganathan, M., Khan, S. S., Butler, J., & Gheorghiade, M. (2015). The vulnerable phase after hospitalization for heart failure. Nat Rev Cardiol, 12(4), 220–229. https://doi.org/10.1038/nrcardio.2015.14
Greene, Stephen J., Gregg C. Fonarow, Muthiah Vaduganathan, Sadiya S. Khan, Javed Butler, and Mihai Gheorghiade. “The vulnerable phase after hospitalization for heart failure.Nat Rev Cardiol 12, no. 4 (April 2015): 220–29. https://doi.org/10.1038/nrcardio.2015.14.
Greene SJ, Fonarow GC, Vaduganathan M, Khan SS, Butler J, Gheorghiade M. The vulnerable phase after hospitalization for heart failure. Nat Rev Cardiol. 2015 Apr;12(4):220–9.
Greene, Stephen J., et al. “The vulnerable phase after hospitalization for heart failure.Nat Rev Cardiol, vol. 12, no. 4, Apr. 2015, pp. 220–29. Pubmed, doi:10.1038/nrcardio.2015.14.
Greene SJ, Fonarow GC, Vaduganathan M, Khan SS, Butler J, Gheorghiade M. The vulnerable phase after hospitalization for heart failure. Nat Rev Cardiol. 2015 Apr;12(4):220–229.

Published In

Nat Rev Cardiol

DOI

EISSN

1759-5010

Publication Date

April 2015

Volume

12

Issue

4

Start / End Page

220 / 229

Location

England

Related Subject Headings

  • Prognosis
  • Patient Readmission
  • Patient Discharge
  • Humans
  • Hospitalization
  • Heart Failure
  • Disease Management
  • Comorbidity
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology