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Timing and Causes of Readmission After Acute Heart Failure Hospitalization-Insights From the Heart Failure Network Trials.

Publication ,  Journal Article
Vader, JM; LaRue, SJ; Stevens, SR; Mentz, RJ; DeVore, AD; Lala, A; Groarke, JD; AbouEzzeddine, OF; Dunlay, SM; Grodin, JL; Dávila-Román, VG ...
Published in: J Card Fail
November 2016

BACKGROUND: Readmission or death after heart failure (HF) hospitalization is a consequential and closely scrutinized outcome, but risk factors may vary by population. We characterized the risk factors for post-discharge readmission/death in subjects treated for acute heart failure (AHF). METHODS AND RESULTS: A post hoc analysis was performed on data from 744 subjects enrolled in 3 AHF trials conducted within the Heart Failure Network (HFN): Diuretic Optimization Strategies Evaluation in Acute Heart Failure (DOSE-AHF), Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF), and Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE-AHF). All-cause readmission/death occurred in 26% and 38% of subjects within 30 and 60 days of discharge, respectively. Non-HF cardiovascular causes of readmission were more common in the ≤30-day timeframe than in the 31-60-day timeframe (23% vs 10%, P = .016). In a Cox proportional hazards model adjusting a priori for left ventricular ejection fraction <50% and trial, the risk factors for all-cause readmission/death included: elevated baseline blood urea nitrogen, angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) non-use, lower baseline sodium, non-white race, elevated baseline bicarbonate, lower systolic blood pressure at discharge or day 7, depression, increased length of stay, and male sex. CONCLUSIONS: In an AHF population with prominent congestion and prevalent renal dysfunction, early readmissions were more likely to be due to non-HF cardiovascular causes compared with later readmissions. The association between use of ACEI/ARB and lower all-cause readmission/death in Cox proportional hazards model suggests a role for these drugs to improve post-discharge outcomes in AHF.

Duke Scholars

Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

November 2016

Volume

22

Issue

11

Start / End Page

875 / 883

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Survival Analysis
  • Stroke Volume
  • Severity of Illness Index
  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Proportional Hazards Models
  • Prognosis
  • Patient Readmission
 

Citation

APA
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ICMJE
MLA
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Vader, J. M., LaRue, S. J., Stevens, S. R., Mentz, R. J., DeVore, A. D., Lala, A., … de las Fuentes, L. (2016). Timing and Causes of Readmission After Acute Heart Failure Hospitalization-Insights From the Heart Failure Network Trials. J Card Fail, 22(11), 875–883. https://doi.org/10.1016/j.cardfail.2016.04.014
Vader, Justin M., Shane J. LaRue, Susanna R. Stevens, Robert J. Mentz, Adam D. DeVore, Anuradha Lala, John D. Groarke, et al. “Timing and Causes of Readmission After Acute Heart Failure Hospitalization-Insights From the Heart Failure Network Trials.J Card Fail 22, no. 11 (November 2016): 875–83. https://doi.org/10.1016/j.cardfail.2016.04.014.
Vader JM, LaRue SJ, Stevens SR, Mentz RJ, DeVore AD, Lala A, et al. Timing and Causes of Readmission After Acute Heart Failure Hospitalization-Insights From the Heart Failure Network Trials. J Card Fail. 2016 Nov;22(11):875–83.
Vader, Justin M., et al. “Timing and Causes of Readmission After Acute Heart Failure Hospitalization-Insights From the Heart Failure Network Trials.J Card Fail, vol. 22, no. 11, Nov. 2016, pp. 875–83. Pubmed, doi:10.1016/j.cardfail.2016.04.014.
Vader JM, LaRue SJ, Stevens SR, Mentz RJ, DeVore AD, Lala A, Groarke JD, AbouEzzeddine OF, Dunlay SM, Grodin JL, Dávila-Román VG, de las Fuentes L. Timing and Causes of Readmission After Acute Heart Failure Hospitalization-Insights From the Heart Failure Network Trials. J Card Fail. 2016 Nov;22(11):875–883.
Journal cover image

Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

November 2016

Volume

22

Issue

11

Start / End Page

875 / 883

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Survival Analysis
  • Stroke Volume
  • Severity of Illness Index
  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Proportional Hazards Models
  • Prognosis
  • Patient Readmission