Key result
Repeated hospital admissions for worsened heart failure were associated with serial clinical deterioration, including an increase in the proportion of patients with a low Barthel Index from 35.8% at the first admission to 44.1% at the fourth admission.
Why the study?
The association of repeated hospital admission for worsened heart failure with clinical manifestations and outcomes was unclear.
Cohort (n=5,740)
Yes
Absolute Event Rate: 44.1% vs 35.8%
p-value: p=<0.001
Repeated hospitalizations for worsened heart failure are associated with a progressive decline in physical function, increased need for advanced organ support, and higher in-hospital mortality.
Heart failure (HF) is a major cause of death and hospitalization worldwide. In particular, hospital readmission due to worsened HF occurs frequently after the onset of HF. However, the association of repeated hospital admission with clinical manifestations and outcomes is unclear. The aim of this study was to clarify the serial changes in presentation and clinical course of patients requiring repeated hospital admission due to worsened HF. Among 466,921 patients who were admitted and discharged between January 2010 and March 2018, with the main discharge diagnosis of HF, we studied 5,740 patients who were hospitalized 4 times or more, using the Diagnosis Procedure Combination database. We evaluated serial changes in continuous data using the Jonckheere trend test, and categorical data using the Cochran-Armitage trend test. The median age of the patients was 78 years, and 3,326 patients (58%) were male. Body mass index and Barthel Index decreased with increased numbers of admissions. Patients requiring respiratory support and hemodialysis increased, whereas patients undergoing intra-aortic balloon pumping decreased with increased numbers of admissions. The length of hospital stay was prolonged and the interval between hospitalizations was shortened with increased numbers of hospital admissions. The in-hospital mortality rate was 8.8% at the fourth admission. In conclusion, this is the first large-scale real-world study on the serial changes in characteristics and outcomes of HF patients requiring repeated hospitalization, suggesting that repeated hospitalization might adversely affect the general status of patients with HF and result in a vicious clinical cycle.
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Itoh et al. (2020) conducted a cohort in Worsened Heart Failure (n=5,740). Repeated hospital admissions (four or more times) vs. First hospital admission was evaluated on Proportion of patients with Barthel Index < 60 (p=<0.001). Repeated hospital admissions for worsened heart failure were associated with serial clinical deterioration, including an increase in the proportion of patients with a low Barthel Index from 35.8% at the first admission to 44.1% at the fourth admission.
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