Premium
The 30‐day metric in acute heart failure revisited: data from IN‐HF Outcome, an Italian nationwide cardiology registry
Author(s) -
Di Tano Giuseppe,
De Maria Renata,
Gonzini Lucio,
Aspromonte Nadia,
Di Lenarda Andrea,
Feola Mauro,
Marini Marco,
Milli Massimo,
Misuraca Gianfranco,
Mortara Andrea,
Oliva Fabrizio,
Pulignano Giovanni,
Russo Giulia,
Senni Michele,
Tavazzi Luigi
Publication year - 2015
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.290
Subject(s) - medicine , heart failure , confidence interval , odds ratio , inotrope , cardiology , logistic regression , emergency medicine
Aims Unplanned readmissions early after a discharge from acute heart failure hospitalization are common and have become a reimbursement benchmark and marker of hospital quality. However, the competing risk of short‐term post‐discharge mortality is substantial. Methods and results Using data from the prospective, nationwide Registry IN‐HF Outcome, we analysed the incidence and predictors of 30‐day mortality or readmissions and associated days‐alive‐out‐of‐hospital ( DAOH ) in 1520 patients discharged alive after admission for acute heart failure. Within 30 days after discharge, 94 patients (6.2%) were readmitted (91% for cardiovascular causes; 60% recurrent heart failure) and 42 (2.8%) died, 10 of which occurred during readmission. Overall, 126 patients (8.3%) met the combined endpoint. By multivariable logistic regression, worsening chronic heart failure as clinical presentation [odds ratio ( OR ) 1.83, 95% confidence interval ( CI ) 1.21–2.77, P = 0.005), inotropes during admission ( OR 2.19, 95% CI 1.40–3.43, P = 0.0006), length of stay ( OR 1.02, 95% CI 1.01–1.04, P = 0.002) and renin–angiotensin system inhibitors at discharge ( OR 0.52, 95% CI 0.35–0.77, P = 0.001) independently predicted 30‐day all‐cause mortality and/or readmission ( c ‐statistic = 0.695). Per cent 30‐day DAOH was lower in patients with in‐hospital inotrope use, no renin–angiotensin system inhibitors prescription at discharge, New York Heart Association III–IV class at discharge, and correlated inversely with length of stay and age. Conclusion A clinical and biohumoral profile consistent with chronic advanced heart failure and end‐organ damage identifies acute heart failure patients discharged home from cardiology units, who are at highest risk of early death and/or readmission. These findings have practical implications for tailoring specific follow‐up.