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Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF.

Publication ,  Journal Article
Fonarow, GC; Abraham, WT; Albert, NM; Stough, WG; Gheorghiade, M; Greenberg, BH; O'Connor, CM; Pieper, K; Sun, JL; Yancy, CW; Young, JB ...
Published in: Arch Intern Med
April 28, 2008

BACKGROUND: Few studies have examined factors identified as contributing to heart failure (HF) hospitalization, and, to our knowledge, none has explored their relationship to length of stay and mortality. This study evaluated the association between precipitating factors identified at the time of HF hospital admission and subsequent clinical outcomes. METHODS: During 2003 to 2004, 259 US hospitals in OPTIMIZE-HF submitted data on 48 612 patients, with a prespecified subgroup of at least 10% providing 60- to 90-day follow-up data. Identifiable factors contributing to HF hospitalization were captured at admission and included ischemia, arrhythmia, nonadherence to diet or medications, pneumonia/respiratory process, hypertension, and worsening renal function. Multivariate analyses were performed for length of stay, in-hospital mortality, 60- to 90-day follow-up mortality, and death/rehospitalization. RESULTS: Mean patient age was 73.1 years, 52% of patients were female, and mean ejection fraction was 39.0%. Of 48 612 patients, 29 814 (61.3%) had 1 or more precipitating factors identified, with pneumonia/respiratory process (15.3%), ischemia (14.7%), and arrhythmia (13.5%) being most frequent. Pneumonia (odds ratio, 1.60), ischemia (1.20), and worsening renal function (1.48) were independently associated with higher in-hospital mortality, whereas uncontrolled hypertension (0.74) was associated with lower in-hospital mortality. Ischemia (1.52) and worsening renal function (1.46) were associated with a higher risk of follow-up mortality. Uncontrolled hypertension as a precipitating factor was associated with lower postdischarge death/rehospitalization (hazard ratio, 0.71). CONCLUSIONS: Precipitating factors are frequently identified in patients hospitalized for HF and are associated with clinical outcomes independent of other predictive variables. Increased attention to these factors, many of which are avoidable, is important in optimizing the management of HF. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00344513.

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Published In

Arch Intern Med

DOI

EISSN

1538-3679

Publication Date

April 28, 2008

Volume

168

Issue

8

Start / End Page

847 / 854

Location

United States

Related Subject Headings

  • Treatment Refusal
  • Renal Insufficiency
  • Registries
  • Pneumonia
  • Patient Readmission
  • Outcome Assessment, Health Care
  • Myocardial Ischemia
  • Multivariate Analysis
  • Male
  • Hypertension
 

Citation

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Fonarow, G. C., Abraham, W. T., Albert, N. M., Stough, W. G., Gheorghiade, M., Greenberg, B. H., … OPTIMIZE-HF Investigators and Hospitals, . (2008). Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch Intern Med, 168(8), 847–854. https://doi.org/10.1001/archinte.168.8.847
Fonarow, Gregg C., William T. Abraham, Nancy M. Albert, Wendy Gattis Stough, Mihai Gheorghiade, Barry H. Greenberg, Christopher M. O’Connor, et al. “Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF.Arch Intern Med 168, no. 8 (April 28, 2008): 847–54. https://doi.org/10.1001/archinte.168.8.847.
Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, et al. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch Intern Med. 2008 Apr 28;168(8):847–54.
Fonarow, Gregg C., et al. “Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF.Arch Intern Med, vol. 168, no. 8, Apr. 2008, pp. 847–54. Pubmed, doi:10.1001/archinte.168.8.847.
Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, O’Connor CM, Pieper K, Sun JL, Yancy CW, Young JB, OPTIMIZE-HF Investigators and Hospitals. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch Intern Med. 2008 Apr 28;168(8):847–854.

Published In

Arch Intern Med

DOI

EISSN

1538-3679

Publication Date

April 28, 2008

Volume

168

Issue

8

Start / End Page

847 / 854

Location

United States

Related Subject Headings

  • Treatment Refusal
  • Renal Insufficiency
  • Registries
  • Pneumonia
  • Patient Readmission
  • Outcome Assessment, Health Care
  • Myocardial Ischemia
  • Multivariate Analysis
  • Male
  • Hypertension