How prior hospitalizations affect a heart failure patient’s chances of survival

Among patients admitted to the hospital for chronic heart failure (HF), prior HF hospitalizations have long been associated with a much higher risk of all-cause mortality. According to new research published in Circulation: Heart Failure, however, this relationship may not be exactly as it seems.

“There is debate whether the hospitalized and post-hospitalized patient with HF represents a distinct biologic entity compared with the patient with chronic stable HF,” wrote lead author Vanessa Blumer, MD, a cardiologist at Duke University School of Medicine, and colleagues. “Specifically, it is uncertain whether a HF hospitalization represents (1) a temporary period of heightened risk or vulnerable phase during which time pathophysiology is exaggerated but subsequently returns to baseline; (2) end-organ injury and/or permanent heightened risk causing an irreversible inflection point in the natural history; or (3) no independent risk but a marker of sicker patients with chronic HF.”

Blumer’s team tracked more than 4,200 patients who were hospitalized for worsening chronic HF with reduced or preserved ejection fraction. Patients were excluded from the study if hospitalized for new-onset HF. All data came from the ASCEND-HF clinical trial.

Overall, 53.3% of patients had at least one prior trip to the hospital for HF within 12 months of their hospitalization. After 180 days, the mortality rate for patients with a prior hospitalization (15.5%) was significantly higher than the rate for patients without that prior hospitalization (11.9%). However, after making certain adjustments, the authors found that the difference between the two groups was no longer statistically significant.

“These results suggest that factors measured during the current patient encounter explain any association between prior HF hospitalization and mortality,” the authors wrote. “Factors measured at the point-of-care, rather than a history of prior HF hospitalization, may serve as a more direct means of predicting patient survival.”

Read the full study here.