Author + information
- Received September 15, 2015
- Revision received February 5, 2016
- Accepted February 7, 2016
- Published online June 1, 2016.
- John R. Kapoor, MD, PhDa,∗ (, )
- Roger Kapoor, MD, MBAb,
- Christine Ju, MSc,
- Paul A. Heidenreich, MD, MSd,
- Zubin J. Eapen, MD, MHSc,
- Adrian F. Hernandez, MD, MHSc,
- Javed Butler, MD, MPH, MBAe,
- Clyde W. Yancy, MD, MBAf and
- Gregg C. Fonarow, MDg
- aChicago Medical School, North Chicago, Illinois
- bUniversity of Illinois, Rockford, Illinois
- cDuke Clinical Research Institute, Durham, North Carolina
- dStanford University, Palo Alto, California
- eDivision of Cardiology, Stony Brook University, Stony Brook, New York
- fNorthwestern University, Chicago, Illinois
- gDivision of Cardiology, University of California Los Angeles, Los Angeles, California
- ↵∗Reprint requests and correspondence:
Dr. John R. Kapoor, Chicago Medical School, 3333 Green Bay Road, North Chicago, Illinois 60064.
Objectives This study assessed the comparative frequency of precipitating clinical factors leading to hospitalization among heart failure (HF) patients with reduced, borderline, and preserved ejection fraction (EF)
Background There are few data assessing the comparative frequency of clinical factors leading to HF among hospitalized among patients with reduced, borderline, and preserved EF.
Methods We analyzed the factors potentially contributing to HF hospitalization among 99,825 HF admissions from 305 hospitals in the Get With The Guidelines-HF (GWTG-HF) database between January 2005 and September 2013 and assessed their association with length of stay and in-hospital mortality.
Results Mean patient age was 72.6 ± 14.2 years, 49% were female, and mean EF was 39.3 ± 17.2%. Common factors included pneumonia/respiratory process (28.2%), arrhythmia (21.7%), medication noncompliance (15.8%), worsening renal failure (14.7%), and uncontrolled hypertension (14.5%). In patients with borderline EF (EF 40% to 49%), pneumonia was associated with longer hospital stay, whereas dietary and medication noncompliance were associated with reduced length of stay. In patients with preserved EF (EF ≥50% or qualitative assessment of normal or mild dysfunction), pneumonia, weight gain, and worsening renal function were independently associated with longer lengths of stay. Worsening renal function and pneumonia were independently associated with higher in-hospital mortality in all HF groups, and acute pulmonary edema was associated with higher mortality in reduced EF. Dietary noncompliance (14.7%) was associated with reduced mortality for all groups but reached statistical significance in the subgroups of reduced (odds ratio [OR]: 0.65; 95% confidence interval [CI]: 0.46 to 0.91) and preserved systolic function (OR: 0.52; 95% CI: 0.33 to 0.83). Patients presenting with ischemia had a higher mortality rate (OR: 1.31; 95% CI: 1.02 to 1.69; and 1.72; 95% CI: 1.27 to 2.33, respectively, in the 2 groups).
Conclusions Potential precipitating factors among patients hospitalized with HF vary by EF group and are independently associated with clinical outcomes.
The Get With The Guidelines-Heart Failure (GWTG-HF) program, provided by the American Heart Association, is currently supported by Medtronic, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. GWTG-HF was supported in the past by GlaxoSmithKline. Dr. Fonarow has received research support from National Heart Lung Blood Institute; and consults for Amgen, Bayer, Janssen, Novartis, and Medtronic. Dr. Eapen is an advisory board member of Amgen, Cytokinetics, and Novartis; consults for Amgen, SHL Telemedicine, and MyoKardia; and has received honoraria from Janssen. Dr. Hernandez has received research grants from Amgen, AstraZeneca, BMS, GlaxoSmithKline, Merck, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 15, 2015.
- Revision received February 5, 2016.
- Accepted February 7, 2016.
- American College of Cardiology Foundation