The predictive model of acute heart failure rehospitalization:  A retrospective study in Prof. I.G.N.G Ngoerah Hospital

Nyoman Ririn Chandrika Sari; Hendy Wirawan; Rani Paramitha Iswari Maliawan; IGN Putra Gunadhi

doi:10.15562/ism.v14i1.1590

The predictive model of acute heart failure rehospitalization: A retrospective study in Prof. I.G.N.G Ngoerah Hospital

Nyoman Ririn Chandrika Sari ,

Hendy Wirawan ,

Rani Paramitha Iswari Maliawan ,

IGN Putra Gunadhi ,

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DOI: https://doi.org/10.15562/ism.v14i1.1590 |
Published: 2023-02-15

Abstract

Introduction. Heart failure is one of the main causes of cardiovascular morbidity and mortality. Research stated that heart failure patients who have undergone 3 rehospitalizations have a survival rate of <50% within 1 year. Therefore, the purpose of this study is to characterize the risk factors that contribute to the occurrence of heart failure rehospitalization.

Method. This is a retrospective analysis of 113 patients with a first hospitalization for heart failure at Prof. I.G.N.G. Ngoerah Hospital between July 2018–February 2020. We collected and compared demographic data, clinical findings, electrocardiogram, laboratory, and echocardiography parameters during the first hospitalization between rehospitalized and non-rehospitalized patients. Rehospitalization was defined as recurrent hospital admission due to worsening heart failure symptoms. Patients were followed for rehospitalization events until death or November 2021.

Results. The rehospitalization rate in this study was 62.8% during a median follow-up of 234 days (12–1098 days). The average of heart failure rehospitalizations during follow-up was 1.73 times (±1.97), with an average length of stay of 6.40 days (±3.27 days). We discovered that the presence of mid/apical rales at admission (odds ratio [OR] 3.509; p=0.027), hyponatremia (<135 mmol/L) at pre-discharge (odds ratio [OR] 3.840; p=0.015), and tricuspid annular plane systolic excursion (TAPSE) values <1.80 cm (odds ratio [OR] 2.905; p=0.020) were independent risk factors for rehospitalization due to worsening heart failure symptoms. Patients with these three independent risk factors have a probability of 96.24% being readmitted.

Conclusion. Mid/apical rales at admission, hyponatremia at pre-discharge, and TAPSE values <1.80 cm in patients admitted for heart failure are associated with further rehospitalization.

References

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Cleland JGF, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The CARE-HF study (cardiac resynchronisation in heart failure study): Rationale, design and end-points. Eur J Heart Fail. 2001;3(4).
National Cancer Institute. Cancer statistics. 2020. https://www.cancer.gov/about- cancer/understanding/statistics.
Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J, Yawn BP, et al. Trends in heart failure incidence and survival in a community-based population. JAMA. 2004;292(3).
Urso C, Brucculeri S, Caimi G. Acid–base and electrolyte abnormalities in heart failure: pathophysiology and implications. Heart Fail Rev. 2015;20(4).
Mesquita ET, Jorge AJL, Rabelo LM, Souza Jr. CV. Understanding Hospitalization in Patients with Heart Failure. Int J Cardiovasc Sci. 2016;
Felker GM, Benza RL, Chandler AB, Leimberger JD, Cuffe MS, Califf RM, et al. Heart failure etiology and response to milrinone in decompensated heart failure: Results from the OPTIME-CHF study. J Am Coll Cardiol. 2003;41(6).
Setoguchi S, Stevenson LW, Schneeweiss S. Repeated hospitalizations predict mortality in the community population with heart failure. Am Heart J. 2007;154(2).
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Vol. 42, European Heart Journal. 2021.
Girerd N, Seronde MF, Coiro S, Chouihed T, Bilbault P, Braun F, et al. Integrative Assessment of Congestion in Heart Failure Throughout the Patient Journey. Vol. 6, JACC: Heart Failure. 2018.
Gheorghiade M, et al. Assessing and grading congestion in acute heart failure: a scientific statement from the acute heart failure committee of the heart failure association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine. Eur J Heart Fail. 2010 May;12(5):423-33. doi: 10.1093/eurjhf/hfq045.
Cooper LB, Lippmann SJ, DiBello JR, Gorsh B, Curtis LH, Sikirica V, et al. The Burden of Congestion in Patients Hospitalized With Acute Decompensated Heart Failure. Am J Cardiol. 2019;124(4).
Solimando AG. Emerging Concepts in Acute Heart Failure: From the Pathophysiology to the Clinical Case Based Approach. Int J Crit Care Emerg Med. 2017;3(1).
Hamaguchi S, Kinugawa S, Tsuchihashi-Makaya M, Matsushima S, Sakakibara M, Ishimori N, et al. Hyponatremia is an independent predictor of adverse clinical outcomes in hospitalized patients due to worsening heart failure. J Cardiol. 2014;63(3).
Roberts JD, Forfia PR. Diagnosis and assessment of pulmonary vascular disease by doppler echocardiography. Vol. 1, Pulmonary Circulation. 2011.
Choudhary G, Lakshmanadoss U, Prasad H, Shah A, Babayan Z, Stapleton D. Poor Right Ventricular Systolic Function (Lower TAPSE) and Higher Pulmonary Artery Systolic Pressure (PASP) Predicts Early Readmissions and All Cause Mortality in Elderly Patients with Heart Failure. J Card Fail. 2014;20(8).
Damy T, Kallvikbacka-Bennett A, Goode K, Khaleva O, Lewinter C, Hobkirk J, et al. Prevalence of, associations with, and prognostic value of tricuspid annular plane systolic excursion (TAPSE) among out-patients referred for the evaluation of heart failure. J Card Fail. 2012;18(3).
Senni M. Prognostic importance of elevated jugular venous pressure and a third heart sound in patients with heart failure. Ital Heart J Suppl. 2001;2(11).

[1] Gheorghiade M, Follath F, Ponikowski P, Barsuk JH, Blair JEA, Cleland JG, et al. Assessing and grading congestion in acute heart failure: A scientific statement from the acute heart failure committee of the heart failure association of the European society of cardiology and endorsed by the European society of intensive care medicine. Eur J Heart Fail. 2010;12(5).

[2] Cleland JGF, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The CARE-HF study (cardiac resynchronisation in heart failure study): Rationale, design and end-points. Eur J Heart Fail. 2001;3(4).

[3] National Cancer Institute. Cancer statistics. 2020. https://www.cancer.gov/about- cancer/understanding/statistics.

[4] Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J, Yawn BP, et al. Trends in heart failure incidence and survival in a community-based population. JAMA. 2004;292(3).

[5] Urso C, Brucculeri S, Caimi G. Acid–base and electrolyte abnormalities in heart failure: pathophysiology and implications. Heart Fail Rev. 2015;20(4).

[6] Mesquita ET, Jorge AJL, Rabelo LM, Souza Jr. CV. Understanding Hospitalization in Patients with Heart Failure. Int J Cardiovasc Sci. 2016;

[7] Felker GM, Benza RL, Chandler AB, Leimberger JD, Cuffe MS, Califf RM, et al. Heart failure etiology and response to milrinone in decompensated heart failure: Results from the OPTIME-CHF study. J Am Coll Cardiol. 2003;41(6).

[8] Setoguchi S, Stevenson LW, Schneeweiss S. Repeated hospitalizations predict mortality in the community population with heart failure. Am Heart J. 2007;154(2).

[9] McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Vol. 42, European Heart Journal. 2021.

[10] Girerd N, Seronde MF, Coiro S, Chouihed T, Bilbault P, Braun F, et al. Integrative Assessment of Congestion in Heart Failure Throughout the Patient Journey. Vol. 6, JACC: Heart Failure. 2018.

[11] Gheorghiade M, et al. Assessing and grading congestion in acute heart failure: a scientific statement from the acute heart failure committee of the heart failure association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine. Eur J Heart Fail. 2010 May;12(5):423-33. doi: 10.1093/eurjhf/hfq045.

[12] Cooper LB, Lippmann SJ, DiBello JR, Gorsh B, Curtis LH, Sikirica V, et al. The Burden of Congestion in Patients Hospitalized With Acute Decompensated Heart Failure. Am J Cardiol. 2019;124(4).

[13] Solimando AG. Emerging Concepts in Acute Heart Failure: From the Pathophysiology to the Clinical Case Based Approach. Int J Crit Care Emerg Med. 2017;3(1).

[14] Hamaguchi S, Kinugawa S, Tsuchihashi-Makaya M, Matsushima S, Sakakibara M, Ishimori N, et al. Hyponatremia is an independent predictor of adverse clinical outcomes in hospitalized patients due to worsening heart failure. J Cardiol. 2014;63(3).

[15] Roberts JD, Forfia PR. Diagnosis and assessment of pulmonary vascular disease by doppler echocardiography. Vol. 1, Pulmonary Circulation. 2011.

[16] Choudhary G, Lakshmanadoss U, Prasad H, Shah A, Babayan Z, Stapleton D. Poor Right Ventricular Systolic Function (Lower TAPSE) and Higher Pulmonary Artery Systolic Pressure (PASP) Predicts Early Readmissions and All Cause Mortality in Elderly Patients with Heart Failure. J Card Fail. 2014;20(8).

[17] Damy T, Kallvikbacka-Bennett A, Goode K, Khaleva O, Lewinter C, Hobkirk J, et al. Prevalence of, associations with, and prognostic value of tricuspid annular plane systolic excursion (TAPSE) among out-patients referred for the evaluation of heart failure. J Card Fail. 2012;18(3).

[18] Senni M. Prognostic importance of elevated jugular venous pressure and a third heart sound in patients with heart failure. Ital Heart J Suppl. 2001;2(11).

The predictive model of acute heart failure rehospitalization: A retrospective study in Prof. I.G.N.G Ngoerah Hospital

Abstract

References

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