Key result
Inpatient heart failure diagnosis linked to ~3-fold higher mortality versus outpatient diagnosis.
Why the study?
The clinical course of heart failure and factors predicting hospitalization and mortality in incident cases were not well described in a population-based sample.
Cohort (n=332)
Incident heart failure patients, particularly those diagnosed as inpatients, are at high risk for subsequent hospitalization and mortality, highlighting the need for targeted interventions in this group.
Inpatient HF diagnosis flags higher-risk patients for closer monitoring; observational data leaves open whether targeted strategies improve outcomes.
AIMS: To describe the clinical course of heart failure in a population-based sample of incident cases, and to identify factors predicting hospitalization and mortality. METHODS AND RESULTS: Three hundred and thirty-two incident cases were identified over 15 months; 208 inpatients and 124 outpatients. Thirty-eight inpatients died during the first hospital admission (case fatality 18%) leaving 294 at risk of subsequent hospitalization. Over an average follow-up of 19 months, 173 cases were hospitalized on 311 occasions. Two hundred and twenty-four (72%) of these admissions were unplanned, with 51% due to worsening heart failure. One hundred and ten cases died over the same period. Cases diagnosed as an inpatient had 26 more admissions for worsening heart failure per 100 cases during follow-up (95% CI 9 to 44) compared to cases diagnosed as an outpatient, and also a higher mortality (hazard ratio 3.1 (95% CI 1.9 to 5.1)). Age was the only factor associated with an increased risk of hospitalization for worsening heart failure, but age, functional class and serum creatinine were predictive of mortality. CONCLUSIONS: New cases of heart failure are at high risk of subsequent hospitalization, especially during the first months after diagnosis. Whilst predicting which patients will be hospitalized is difficult, interventions designed to reduce hospitalizations for worsening heart failure should be targeted at elderly inpatients with a new diagnosis.
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Martín Cowie (2002) conducted a cohort in Heart failure (n=332). Inpatient diagnosis vs. Outpatient diagnosis was evaluated on Mortality (HR 3.1, 95% CI 1.9 to 5.1). Heart failure cases diagnosed as an inpatient had a higher mortality (HR 3.1; 95% CI 1.9-5.1) and more admissions for worsening heart failure compared to cases diagnosed as an outpatient.
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