AIM: Researchers identify precipitating factors to help manage HF patients

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Increased attention to precipitating factors, frequently identified in patients hospitalized for heart failure (HF), such as pneumonia, irregular heart beats, and obstructed blood flow to the heart, is important in optimizing HF management, according to a study published in the April 28 issue of Archives of Internal Medicine.

The authors noted that prior to the study, few studies have examined factors identified as contributing to HF hospitalization, “and, to our knowledge, none has explored their relationship to length of stay and mortality.”

As a result, Gregg C. Fonarow, MD, from the department of medicine at the University of California at Los Angeles Medical Center, and colleagues undertook the study to evaluate the association between precipitating factors identified at the time of HF hospital admission and subsequent clinical outcomes.

During 2003 to 2004, 259 U.S. hospitals in OPTIMIZE-HF submitted data on 48,612 patients, with a pre-specified subgroup of at least 10 percent providing 60- to 90-day follow-up data, the according to researchers. The reported that the identifiable factors contributing to HF hospitalization were captured at admission and included ischemia, arrhythmia, nonadherence to diet or medications, pneumonia/respiratory process, hypertension and worsening renal function.

The investigators performed multivariate analyses for length of stay, in-hospital mortality, 60- to 90-day follow-up mortality and death/rehospitalization.

Fonarow and colleagues reported that the mean patient age was 73.1 years, 52 percent of patients were female and the mean ejection fraction was 39 percent.

Overall, of the 48,612 patients, the researchers found that 29,814 (61.3 percent) had one or more precipitating factors identified, with pneumonia/respiratory process (15.3 percent), ischemia (14.7 percent) and arrhythmia (13.5 percent) being most frequent.

Pneumonia, ischemia and worsening renal function were independently associated with higher in-hospital mortality, whereas uncontrolled hypertension was associated with lower in-hospital mortality, according to investigators. Ischemia and worsening renal function were associated with a higher risk of follow-up mortality. Uncontrolled hypertension as a precipitating factor was associated with lower post-discharge death/rehospitalization, the researchers said.

"The study offers important insight and points to where we can intervene early, such as making sure patients with heart failure are immunized against flu and pneumonia,” Fonarow said in a statement.

He added that some conditions are easier to handle, for example, helping patients get back onto blood pressure medication, or follow a more sensible diet. This may explain why the results showed lower mortality and shorter hospital stays for patients who were admitted with these factors.

Fonarow said he and his team were planning future studies to examine how “specific interventions based on these precipitating factors, such as flu vaccinations, may help this high-risk heart failure population."

Approximately 5 million Americans have heart failure every year. The condition leads to 3.6 million hospital admissions a year in the U.S.