Postdischarge Assessment After a Heart Failure Hospitalization

Heart failure (HF) is the most frequent cause of hospitalization for patients >65 years of age.1,–,5 More than 1 million patients are admitted to the hospital with HF each year in the United States, and this number is likely to increase because of aging of the general population, improved survival after acute cardiovascular conditions, and prevention of sudden cardiac death. Hospitalization for HF is one of the most powerful independent risk factors for death among patients with HF. Mortality during the initial hospitalization ranges from 6% to 7% in Europe to 3% to 4% in the United States, depending on the length of hospital stay.1,2 Poor outcomes have universally been shown after discharge, with 60- to 90-day mortality rates of 5% to 15% and hospital readmission rates of 30%.1,6,7 Depending on the duration of the first hospitalization and on the number of previous hospitalizations, the risk of dying after a hospitalization for HF is increased from 4-fold to 16-fold compared with before the hospitalization.8Article see p 1806Whereas the prognosis of patients with chronic HF has improved in recent years, there has been no change in the high risk of death or rehospitalization after an HF hospitalization.6,9–11 This has multiple causes. First, the hospitalization for HF may be the expression of end-stage HF. In these patients, all therapies have already been tried and have become ineffective or were not tolerated. There are no chances to improve their symptoms and prognosis except with the use of assist devices or heart transplantation. These patients, however, are only a small proportion, <5%, of all the patients hospitalized for HF. An improvement in outcomes is possible in the others.1,12 In addition …