Key result
Each increase in NYHA class at discharge was associated with a 3.4-fold higher risk of 90-day cardiac events (95% CI 1.4-8.5), while orthopnea increased risk 12.8-fold (95% CI 1.7-99.7).
Why the study?
Do simple assessments of function and symptoms predict short-term cardiac event-free survival in hospitalized HF patients?
Cohort (n=32)
Do simple assessments of function and symptoms predict short-term cardiac event-free survival in hospitalized HF patients?
Hazard Ratio: 3.4 (95% CI 1.4–8.5)
Simple assessments of function and symptoms at discharge, such as NYHA class and presence of orthopnea, strongly predict 90-day cardiac events in hospitalized heart failure patients.
May aid short-term HF risk stratification at discharge; leaves open need for prospective validation before guiding interventions.
Background. Heart failure (HF) is a prevalent chronic condition where patients experience numerous uncomfortable symptoms, low functional status, and high mortality rates. Objective. To determine whether function and/or symptoms predict cardiac event-free survival in hospitalized HF patients within 90 days of hospital discharge. Methods. Inpatients (N = 32) had HF symptoms assessed with 4 yes/no questions. Function was determined with NYHA Classification, Katz Index of Activities of Daily Living (ADLs), and directly with the short physical performance battery (SPPB). Survival was analyzed with time to the first postdischarge cardiac event with events defined as cardiac rehospitalization, heart transplantation, or death. Results. Mean age was 58.2 ± 13.6 years. Patient reported ADL function was nearly independent (5.6 ± 1.1) while direct measure (SPPB) showed moderate functional limitation (6.4 ± 3.1). Within 90 days, 40.6% patients had a cardiac event. At discharge, each increase in NYHA Classification was associated with a 3.4-fold higher risk of cardiac events (95% CI 1.4-8.5). Patients reporting symptoms of dyspnea, fatigue, and orthopnea before discharge had a 4.0-fold, 9.7-fold, and 12.8-fold, respectively, greater risk of cardiac events (95% CI 1.2-13.2; 1.2-75.1; 1.7-99.7). Conclusions. Simple assessments of function and symptoms easily performed at discharge may predict short-term cardiac outcomes in hospitalized HF patients.
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Zaharias et al. (2014) conducted a cohort in Heart failure (n=32). Higher NYHA Classification and symptoms (dyspnea, fatigue, orthopnea) vs. Lower NYHA Classification and absence of symptoms was evaluated on Time to the first postdischarge cardiac event (cardiac rehospitalization, heart transplantation, or death) (HR 3.4, 95% CI 1.4-8.5). Each increase in NYHA class at discharge was associated with a 3.4-fold higher risk of 90-day cardiac events (95% CI 1.4-8.5), while orthopnea increased risk 12.8-fold (95% CI 1.7-99.7).
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