Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure

Patients with chronic heart failure (HF) are at increased risk of both fatal and nonfatal major adverse cardiovascular events. We used data from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) trials to assess the influence of nonfatal hospitalizations fo...

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Vydáno v:	Circulation (New York, N.Y.) Ročník 116; číslo 13; s. 1482
Hlavní autoři:	Solomon, Scott D, Dobson, Joanna, Pocock, Stuart, Skali, Hicham, McMurray, John J V, Granger, Christopher B, Yusuf, Salim, Swedberg, Karl, Young, James B, Michelson, Eric L, Pfeffer, Marc A
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 25.09.2007
Témata:	Aftercare Aged Aged, 80 and over Angiotensin II Type 1 Receptor Blockers - therapeutic use Benzimidazoles - therapeutic use Death, Sudden, Cardiac - epidemiology Disease Progression Female Follow-Up Studies Heart Failure - drug therapy Heart Failure - mortality Hospitalization - statistics & numerical data Humans Male Middle Aged Proportional Hazards Models Randomized Controlled Trials as Topic - statistics & numerical data Survival Analysis Tetrazoles - therapeutic use
ISSN:	1524-4539, 1524-4539
On-line přístup:	Zjistit podrobnosti o přístupu
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Abstract	Patients with chronic heart failure (HF) are at increased risk of both fatal and nonfatal major adverse cardiovascular events. We used data from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) trials to assess the influence of nonfatal hospitalizations for HF on subsequent mortality rates in a broad spectrum of HF patients. In the present study, 7599 patients with New York Heart Association class II to IV HF and reduced or preserved left ventricular ejection fraction were randomized to placebo or candesartan. We assessed the risk of death after discharge from a first hospitalization for HF using time-updated Cox proportional-hazards models on 7572 patients for whom discharge data were available. Of 7572 patients, 1455 (19%) had at least 1 HF hospitalization, and 586 of 1819 deaths occurred after discharge from an HF hospitalization. The mortality rate was increased after HF hospitalizations, even after adjustment for baseline predictors of death (hazard ratio, 3.15; 95% confidence interval, 2.83 to 3.50). Longer duration of HF hospitalization enhanced the risk of dying, as did repeat HF hospitalizations. Moreover, risk of death was highest within a month of discharge and then declined progressively over time, particularly for death resulting from HF progression and for sudden cardiac death. We observed a similar pattern of risk associated with all-cause hospitalization, although the magnitude was less than that with HF hospitalization. In patients with chronic HF, the risk of death is greatest in the early period after discharge after a hospitalization for HF and is directly related to the duration and frequency of HF hospitalizations. These findings suggest a role for increased surveillance in the early postdischarge period of greatest vulnerability after an HF admission.
AbstractList	Patients with chronic heart failure (HF) are at increased risk of both fatal and nonfatal major adverse cardiovascular events. We used data from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) trials to assess the influence of nonfatal hospitalizations for HF on subsequent mortality rates in a broad spectrum of HF patients.BACKGROUNDPatients with chronic heart failure (HF) are at increased risk of both fatal and nonfatal major adverse cardiovascular events. We used data from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) trials to assess the influence of nonfatal hospitalizations for HF on subsequent mortality rates in a broad spectrum of HF patients.In the present study, 7599 patients with New York Heart Association class II to IV HF and reduced or preserved left ventricular ejection fraction were randomized to placebo or candesartan. We assessed the risk of death after discharge from a first hospitalization for HF using time-updated Cox proportional-hazards models on 7572 patients for whom discharge data were available. Of 7572 patients, 1455 (19%) had at least 1 HF hospitalization, and 586 of 1819 deaths occurred after discharge from an HF hospitalization. The mortality rate was increased after HF hospitalizations, even after adjustment for baseline predictors of death (hazard ratio, 3.15; 95% confidence interval, 2.83 to 3.50). Longer duration of HF hospitalization enhanced the risk of dying, as did repeat HF hospitalizations. Moreover, risk of death was highest within a month of discharge and then declined progressively over time, particularly for death resulting from HF progression and for sudden cardiac death. We observed a similar pattern of risk associated with all-cause hospitalization, although the magnitude was less than that with HF hospitalization.METHODS AND RESULTSIn the present study, 7599 patients with New York Heart Association class II to IV HF and reduced or preserved left ventricular ejection fraction were randomized to placebo or candesartan. We assessed the risk of death after discharge from a first hospitalization for HF using time-updated Cox proportional-hazards models on 7572 patients for whom discharge data were available. Of 7572 patients, 1455 (19%) had at least 1 HF hospitalization, and 586 of 1819 deaths occurred after discharge from an HF hospitalization. The mortality rate was increased after HF hospitalizations, even after adjustment for baseline predictors of death (hazard ratio, 3.15; 95% confidence interval, 2.83 to 3.50). Longer duration of HF hospitalization enhanced the risk of dying, as did repeat HF hospitalizations. Moreover, risk of death was highest within a month of discharge and then declined progressively over time, particularly for death resulting from HF progression and for sudden cardiac death. We observed a similar pattern of risk associated with all-cause hospitalization, although the magnitude was less than that with HF hospitalization.In patients with chronic HF, the risk of death is greatest in the early period after discharge after a hospitalization for HF and is directly related to the duration and frequency of HF hospitalizations. These findings suggest a role for increased surveillance in the early postdischarge period of greatest vulnerability after an HF admission.CONCLUSIONSIn patients with chronic HF, the risk of death is greatest in the early period after discharge after a hospitalization for HF and is directly related to the duration and frequency of HF hospitalizations. These findings suggest a role for increased surveillance in the early postdischarge period of greatest vulnerability after an HF admission. Patients with chronic heart failure (HF) are at increased risk of both fatal and nonfatal major adverse cardiovascular events. We used data from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) trials to assess the influence of nonfatal hospitalizations for HF on subsequent mortality rates in a broad spectrum of HF patients. In the present study, 7599 patients with New York Heart Association class II to IV HF and reduced or preserved left ventricular ejection fraction were randomized to placebo or candesartan. We assessed the risk of death after discharge from a first hospitalization for HF using time-updated Cox proportional-hazards models on 7572 patients for whom discharge data were available. Of 7572 patients, 1455 (19%) had at least 1 HF hospitalization, and 586 of 1819 deaths occurred after discharge from an HF hospitalization. The mortality rate was increased after HF hospitalizations, even after adjustment for baseline predictors of death (hazard ratio, 3.15; 95% confidence interval, 2.83 to 3.50). Longer duration of HF hospitalization enhanced the risk of dying, as did repeat HF hospitalizations. Moreover, risk of death was highest within a month of discharge and then declined progressively over time, particularly for death resulting from HF progression and for sudden cardiac death. We observed a similar pattern of risk associated with all-cause hospitalization, although the magnitude was less than that with HF hospitalization. In patients with chronic HF, the risk of death is greatest in the early period after discharge after a hospitalization for HF and is directly related to the duration and frequency of HF hospitalizations. These findings suggest a role for increased surveillance in the early postdischarge period of greatest vulnerability after an HF admission.
Author	Michelson, Eric L Pfeffer, Marc A Skali, Hicham Swedberg, Karl Young, James B Pocock, Stuart Dobson, Joanna Yusuf, Salim Solomon, Scott D Granger, Christopher B McMurray, John J V
Author_xml	– sequence: 1 givenname: Scott D surname: Solomon fullname: Solomon, Scott D email: ssolomon@rics.bwh.harvard.edu organization: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. ssolomon@rics.bwh.harvard.edu – sequence: 2 givenname: Joanna surname: Dobson fullname: Dobson, Joanna – sequence: 3 givenname: Stuart surname: Pocock fullname: Pocock, Stuart – sequence: 4 givenname: Hicham surname: Skali fullname: Skali, Hicham – sequence: 5 givenname: John J V surname: McMurray fullname: McMurray, John J V – sequence: 6 givenname: Christopher B surname: Granger fullname: Granger, Christopher B – sequence: 7 givenname: Salim surname: Yusuf fullname: Yusuf, Salim – sequence: 8 givenname: Karl surname: Swedberg fullname: Swedberg, Karl – sequence: 9 givenname: James B surname: Young fullname: Young, James B – sequence: 10 givenname: Eric L surname: Michelson fullname: Michelson, Eric L – sequence: 11 givenname: Marc A surname: Pfeffer fullname: Pfeffer, Marc A
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/17724259$$D View this record in MEDLINE/PubMed
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CorporateAuthor	Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) Investigators
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References	18591445 - Circulation. 2008 Jul 1;118(1):e7; author reply e8
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Snippet	Patients with chronic heart failure (HF) are at increased risk of both fatal and nonfatal major adverse cardiovascular events. We used data from the...
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SubjectTerms	Aftercare Aged Aged, 80 and over Angiotensin II Type 1 Receptor Blockers - therapeutic use Benzimidazoles - therapeutic use Death, Sudden, Cardiac - epidemiology Disease Progression Female Follow-Up Studies Heart Failure - drug therapy Heart Failure - mortality Hospitalization - statistics & numerical data Humans Male Middle Aged Proportional Hazards Models Randomized Controlled Trials as Topic - statistics & numerical data Survival Analysis Tetrazoles - therapeutic use
Title	Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure
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