Prognostic Factors in Patients Hospitalized for Heart Failure
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EPIDEMIOLOGY OF HEART FAILURE (J BUTLER, SECTION EDITOR)
Prognostic Factors in Patients Hospitalized for Heart Failure Lakshmi Sridharan & Liviu Klein
Published online: 10 October 2013 # Springer Science+Business Media New York 2013
Abstract Each year, there are over one million hospitalizations for heart failure in the United States, with a similar number in Western Europe. Although these patients respond to initial therapies, they have very high short and intermediate term (2-6 months) mortality and readmission rates, while the healthcare system incurs substantial costs. Several risk prediction models that can accurately identify high-risk patients have been developed using data from clinical trials, large registries or administrative databases. Use of multi-variable risk models at the time of hospital admission or discharge offers better risk stratification and should be encouraged, as it allows for appropriate allocation of existing resources and development of clinical trials testing new treatment strategies for patients admitted with heart failure. Keywords Heart failure . Hospitalizations . Prognostic factors . Risk factors
Introduction Hospitalizations for heart failure (HFH) are a considerable health care burden, with over one million annual hospital discharges in the United States [1, 2••], a number that has not decreased in the last decade. The 30-day readmission rate approaches 25 % [3, 4••], the subsequent one-year mortality rate is nearly 30 %, and hospital costs carry a price tag of $30 billion dollars [5, 6], most of which is directly absorbed by the Medicare health system. In this context, much attention has been paid to the ability of finding prognostic factors during the index HFH that can L. Sridharan : L. Klein (*) Division of Cardiology, University of California San Francisco, 505 Parnassus Avenue, Room M1178B, San Francisco, CA 94143, USA e-mail: [email protected]
potentially be addressed and lead to prevention of rehospitalizations. Understanding the relevant predictors of HFH is an important step in defining individual risk, building risk models and pursuing preventive strategies that can help contain costs and improve morbidity and mortality in this patient population.
Definition A HFH is defined as an unplanned visit to a healthcare facility for which HF symptoms (dyspnea on exertion, dyspnea at rest, orthopnea, paroxysmal nocturnal dyspnea, cough, fatigue, leg edema, nausea/ vomiting, poor appetite, abdominal bloating, right upper quadrant pain) are the main reasons for presentation and for which HF is recorded as the primary or secondary diagnosis at the time of discharge. Due to the different setup specific to individual healthcare facilities, as well as to various administrative and reimbursement issues, patients presenting to medical attention with HF symptoms may be treated in the Emergency Department and subsequently released, admitted for a short period (less than 48 hrs) in Observation/ Short Stay Units, or admitted to the hospital for a longer duration of treatment. T
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