engleski

Predictors of rehospitalization in patients with decompensated chronic heart failure

Purpose: To identify demographic, clinical and laboratory variables in hospitalized patients with decompensated chronic heart failure associated with a higher likelihood of rehospitalization. Methods: We performed retrospective cohort study of 329 patients, consecutively admitted to our department with decompensated chronic heart failure between January 2011 and December 2011. Only patients dismissed alive were included in further analysis. According to the presence or absence of rehospitalization, study population was divided in two groups: non-rehospitalized (n=278) and rehospitalized patients (n=51). Rehospitalization was taken into consideration if it had happened during one year period from the first day of index hospitalization. Data were compared using the test of proportions for categorical variables and t-test or ANOVA for continuous variables, with Tukey HSD post-hoc test. MedCalc v. 12.2.1.0. and Statistica 10 for Windows were used for statistical analyses. Results: There were 51 (15%) patients who have been rehospitalized: 5 (10%) in the first 30 days, 12 (23%) between 31-60 days and 34 (67%) after more than 60 days. Non-rehospitalized and rehospitalized patients did not differ significantly in age (74.1±10.0 vs. 75.2±9.9 years), gender, cardiovascular risk factors (smoking, diabetes, hypertension), ischemic etiology of heart failure (43 vs. 51%), associated cardiovascular disease, chronic obstructive pulmonary disease (16 vs. 14%), systolic blood pressure, resting heart rate, NYHA class, left ventricular ejection fraction (41 vs. 36%) and length of index hospitalization (9.9±4.5 vs. 10.0±4.8 days). No significant difference was found neither in mean sodium, uric acid, troponin I, CRP and hemoglobin concentration. In spite of that, mean serum urea and creatinine values were higher in rehospitalized group (12.2±5.8 vs. 10.4±6.7 mmol/L, p=0.043 ; and 144.3±60.8 vs. 118.6±52.8 μmol/L, p=0.002). Mean estimated glomerular filtration rate was significantly lower in those patients (45.9±20.7 vs. 57.2±26.9 ml/min/1.73m2, p=0.005). No significant differences in pharmacological treatment at discharge of index hospitalization were present between two groups, regarding use of beta-blockers, ACE inhibitors or angiotensin receptor blockers, and aldosterone antagonists. Conclusion: Elevated urea and creatinine serum concentrations, and lower estimated glomerular filtration rate are the main predictors of rehospitalization in patients with decompensated chronic heart failure.

heart failure; renal failure; prognosis; hospitalization

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