Key result
Loop diuretics use at discharge was independently associated with an increased risk of heart failure rehospitalization (HR 2.622), along with age ≥ 75 years, diabetes mellitus, and heart rate ≥ 75 bpm.
Cohort (n=282)
No
Hazard Ratio: 2.622 (95% CI 1.005–3.272)
p-value: p=0.043
Age ≥ 75 years, diabetes mellitus, elevated heart rate (≥ 75 bpm), and loop diuretic use at discharge are simple, independent clinical predictors of rehospitalization in patients following their first acute heart failure admission.
Should not yet change diuretic prescribing; leaves open whether use marks severity or contributes to rehospitalization risk.
Repeated hospitalization due to acute decompensated heart failure (HF) is a pandemic health problem in Japan. However, it is difficult to predict rehospitalization after discharge for acute decompensated HF. We used a single hospital-based cohort from the Shinken Database 2004-2012, comprising all new patients (n = 19,994) who visited the Cardiovascular Institute Hospital. A total of 282 patients discharged after their first acute HF admission were included in the analysis. The median follow-up period was 908 ± 865 days. Of these patients, rehospitalization due to worsening HF occurred in 55 patients. The cumulative rate of rehospitalization was 17.5% at 1 year, 21.4% at 2 years, and 25.5% at 3 years. Patients with rehospitalization were older than those without rehospitalization. Prevalence of diabetes mellitus (DM) was more common in patients with rehospitalization. Average heart rate (HR) tended to be higher in patients with rehospitalization. Loop diuretics were more commonly used at hospital discharge in patients with rehospitalization. Multivariate Cox regression analysis revealed that age ≥ 75 years, DM, HR ≥ 75 bpm at discharge, and use of loop diuretics at discharge were independent predictors for rehospitalization. The number of these independent risk factors could be used to clearly discriminate between the HF rehospitalization low-, middle- and high-risk patients. HF rehospitalization commonly occurred in patients who were discharged after their first acute HF admission. Older age, DM, increased HR, and loop diuretics use at discharge were independently associated with HF rehospitalization. By simply counting these risk factors, we might be able to predict the risk of HF rehospitalization after discharge.
No takes yet. Share an insight, caveat, or question.
Kaneko et al. (2015) conducted a cohort in Acute decompensated heart failure (n=282). Loop diuretics use at discharge vs. No loop diuretics use at discharge was evaluated on Heart failure rehospitalization (HR 2.622, 95% CI 1.005-3.272, p=0.043). Loop diuretics use at discharge was independently associated with an increased risk of heart failure rehospitalization (HR 2.622), along with age ≥ 75 years, diabetes mellitus, and heart rate ≥ 75 bpm.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: