What is the clinical evidence from this study?

Study design: Cohort. Population: Decompensated heart failure (n=299). Intervention: Worsening renal function (WRF) vs. No worsening renal function. Primary outcome: Length of stay (days) (p=0.006).

What does this research mean for the field?

Worsening renal function occurs in 29% of patients hospitalized with decompensated heart failure and is associated with a longer median length of stay, but not with increased mortality or re-hospitalization rates when major in-hospital complications are excluded. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 19, 2006Open Access

Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH)

Key Result

Worsening renal function occurred in 29% of patients hospitalized with decompensated heart failure and was associated with a longer median length of stay (11 vs. 9 days, P=0.006).

Study Design

Type

Cohort (n=299)

Multicenter

Yes

Structured PICO

Population

299 patients hospitalized for decompensated heart failure with a history of ejection fraction <=40%, mean age 68, 74% men, across eight European countries.

Outcome

Prevalence and risk factors for worsening renal function (increase in serum creatinine >26 micromol/L from admission), and association with subsequent re-hospitalization and mortality at 6 monthshard clinical

Worsening renal function is common in patients hospitalized with decompensated HFrEF and prolongs hospital stay, but may not independently increase 6-month mortality or re-hospitalization when major in-hospital complications are excluded.

Main Result

Absolute Event Rate: 11% vs 9%

p-value: p=0.006

Abstract

AIMS: To determine the prevalence and risk factors for worsening renal function (WRF) among patients hospitalized for decompensated heart failure (HF) and the association with subsequent re-hospitalization and mortality. METHODS AND RESULTS: We prospectively enrolled 299 patients across eight European countries (mean age 68, 74% men). HF was defined using the European Society of Cardiology criteria, but only patients with a history of ejection fraction 26 micromol/L ( approximately 0.3 mg/dL) from admission. Follow-up was 95% complete to 6 months. Nearly one-third of patients 72 of 248 patients, 29% (95% CI 26-32%) developed WRF during hospitalization, excluding patients who had a major in-hospital complication likely to compromise renal function. The risk of WRF in this group was independently associated with serum creatinine levels on admission odds ratio (OR) 3.02 (95% CI 1.58-5.76), pulmonary oedema OR 3.35 (1.79-6.27), and a history of atrial fibrillation OR 0.35 (0.18-0.67). Although the mortality of WRF patients was not increased significantly, the length of stay was 2 days longer median 11 days (90% range (4-41) vs. 9 days (4-34), P=0.006. The re-hospitalization rate was similar in both groups. CONCLUSION: WRF is common in patients admitted to European hospitals with decompensated HF. Such patients have longer duration admissions, but a similar mortality and re-hospitalization rate to those without WRF (if patients experiencing a major in-hospital complication are excluded).