Critical elements of clinical follow-up after hospital discharge for heart failure: Insights from the EVEREST trial

Shannon M. Dunlay, Mihai Gheorghiade, Kimberly J. Reid, Larry A. Allen, Paul S. Chan, Paul J. Hauptman, Faiez Zannad, Aldo P. Maggioni, Karl Swedberg, Marvin A. Konstam, John A. Spertus

Research output: Contribution to journalArticle

52 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)367-374
Number of pages8
JournalEuropean Journal of Heart Failure
Volume12
Issue number4
DOIs
StatePublished - Apr 2010

Keywords

  • BNP
  • Health status
  • Heart failure
  • Hospitalization
  • Mortality
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Dunlay, S. M., Gheorghiade, M., Reid, K. J., Allen, L. A., Chan, P. S., Hauptman, P. J., Zannad, F., Maggioni, A. P., Swedberg, K., Konstam, M. A., & Spertus, J. A. (2010). Critical elements of clinical follow-up after hospital discharge for heart failure: Insights from the EVEREST trial. European Journal of Heart Failure, 12(4), 367-374. https://doi.org/10.1093/eurjhf/hfq019