EJHF: Aggressive follow-up best for heart failure patients
Aggressive device therapy, more frequent follow-ups and better heart failure (HF) management programs could help decrease mortality and readmission rates of heart failure patients, according to a study published online March 1 in the European Journal of Heart Failure.

Shannon M. Dunlay, MD, from the Mayo Clinic in Rochester, Minn., and colleagues used data from the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan) trial to evaluate 1,528 patients hospitalized with HF to find the factors that were most closely associated with poor outcomes one-week after hospital discharge.

“We evaluated which components of the one-week follow-up visit offered the greatest incremental value in predicting cardiovascular rehospitalization and mortality,” said coauthor John Spertus, professor at the University of Missouri in Kansas City, Mo.

The authors used Cox models, c-statistics and integrated discrimination improvements (IDI) to evaluate both mortality and hospital readmittance rates.

According to the researchers, the c-statistic for history and medications was 0.657. Use of physical exam, laboratory and KCCQ results produced ICI increases of 4.9, 7.0 and 3.2 percent, respectively. The researchers found that by combining all three factors increased the IDI by 10.8 percent.

"The combination of all three [factors] provided the greatest accuracy in risk stratification. So it's our belief that a comprehensive assessment one week after hospital discharge, which includes patient history, review of medications, targeted physical examination, laboratory and health status assessments, may represent the best strategy for identifying HF patients at highest risk for adverse outcomes,” Spertus said.

In addition, the researchers found that for HF patients, evaluating health status, performing a physical exam and an evaluation of biomarkers, specifically natriuretic peptides, anemia and kidney function, best predicted one-year rehospitalization and mortality rates.

"By clarifying which domains of follow-up evaluation are most important, more efficient strategies for managing discharged HF patients could then be designed,” Spertus concluded.