Renal Function, Health Outcomes, and Resource Utilization in Acute Heart Failure

A cute heart failure (AHF) is common and is associated with adverse outcomes among chronic HF patients. 3] AHF patients are also particularly prone to readmission, with reported readmission rates between 44% to 60% within 6 to 9 months of discharge. 7,8 AHF hospitalizations account for more than half of the costs of HF treatment, 2,9 which in the United States are projected to reach $37 billion in 2009. 6] However, despite its importance, there is no clear consensus on how RI and WRF should be defined and to what extent these conditions affect outcomes in AHF specifically. wo recent systematic reviews and meta-analyses have evaluated the association of RI and long-term mortality in HF 23 as well as the association of WRF and mortality and readmission risk. Smith et al, 23 in a meta-analysis of 7 chronic HF (n16 106) and 2 AHF (n54 305) studies found a 56% increase in long-term mortality risk with severe renal impairment; moreover, WRF was associated with a 47% increase in the risk of 6-month mortality, but there was only marginal association with readmissions in AHF patients. amman et al 17 reported a 61% increase in risk of mortality and 30% risk of all-cause readmission associated with WRF after 2 to 6 months of follow-up. Although these studies provide valuable insights, they were not designed to assess outcomes specifically in AHF and did not address short-term health and health care resource outcomes such as in-hospital mortality, risk of complications, and length of stay (LOS), which are uniquely relevant to AHF patients. The objective of this systematic review was to enumerate the range of studies that have assessed the impact of RI and WRF on short-and long-term health outcomes and health care resource use in adult AHF patients. We also describe the range of definitions for RI and WRF as well as compare the associations of these definitions with relevant outcomes in AHF.