TY - JOUR
T1 - Critical elements of clinical follow-up after hospital discharge for heart failure
T2 - Insights from the EVEREST trial
AU - Dunlay, Shannon M.
AU - Gheorghiade, Mihai
AU - Reid, Kimberly J.
AU - Allen, Larry A.
AU - Chan, Paul S.
AU - Hauptman, Paul J.
AU - Zannad, Faiez
AU - Maggioni, Aldo P.
AU - Swedberg, Karl
AU - Konstam, Marvin A.
AU - Spertus, John A.
PY - 2010/4
Y1 - 2010/4
N2 - Aims Hospitalized heart failure (HF) patients are at high risk for death and readmission. We examined the incremental value of data obtained 1 week after HF hospital discharge in predicting mortality and readmission.Methods and resultsIn the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with tolvaptan, 1528 hospitalized patients (ejection fraction ≤40) with a physical examination, laboratories, and health status [Kansas City Cardiomyopathy Questionnaire (KCCQ)] assessments 1 week after discharge were included. The ability to predict 1 year cardiovascular rehospitalization and mortality was assessed with Cox models, c-statistics, and the integrated discrimination improvement (IDI). Not using a beta-blocker, rales, pedal oedema, hyponatraemia, lower creatinine clearance, higher brain natriuretic peptide, and worse health status were independent risk factors for rehospitalization and death. The c-statistic for the base model (history and medications) was 0.657. The model improved with physical examination, laboratory, and KCCQ results, with IDI increases of 4.9, 7.0, and 3.2, respectively (P < 0.001 each). The combination of all three offered the greatest incremental gain (c-statistic 0.749; IDI increase 10.8).ConclusionPhysical examination, laboratories, and KCCQ assessed 1 week after discharge offer important prognostic information, suggesting that all are critical components of outpatient evaluation after HF hospitalization.
AB - Aims Hospitalized heart failure (HF) patients are at high risk for death and readmission. We examined the incremental value of data obtained 1 week after HF hospital discharge in predicting mortality and readmission.Methods and resultsIn the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with tolvaptan, 1528 hospitalized patients (ejection fraction ≤40) with a physical examination, laboratories, and health status [Kansas City Cardiomyopathy Questionnaire (KCCQ)] assessments 1 week after discharge were included. The ability to predict 1 year cardiovascular rehospitalization and mortality was assessed with Cox models, c-statistics, and the integrated discrimination improvement (IDI). Not using a beta-blocker, rales, pedal oedema, hyponatraemia, lower creatinine clearance, higher brain natriuretic peptide, and worse health status were independent risk factors for rehospitalization and death. The c-statistic for the base model (history and medications) was 0.657. The model improved with physical examination, laboratory, and KCCQ results, with IDI increases of 4.9, 7.0, and 3.2, respectively (P < 0.001 each). The combination of all three offered the greatest incremental gain (c-statistic 0.749; IDI increase 10.8).ConclusionPhysical examination, laboratories, and KCCQ assessed 1 week after discharge offer important prognostic information, suggesting that all are critical components of outpatient evaluation after HF hospitalization.
KW - BNP
KW - Health status
KW - Heart failure
KW - Hospitalization
KW - Mortality
KW - Prognosis
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U2 - 10.1093/eurjhf/hfq019
DO - 10.1093/eurjhf/hfq019
M3 - Article
C2 - 20197265
AN - SCOPUS:77950295232
SN - 1388-9842
VL - 12
SP - 367
EP - 374
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 4
ER -