Clinical events leading to the progression of heart failure: insights froma national database of hospital discharges

Citation
Au. Khand et al., Clinical events leading to the progression of heart failure: insights froma national database of hospital discharges, EUR HEART J, 22(2), 2001, pp. 153-164
Citations number
58
Categorie Soggetti
Cardiovascular & Respiratory Systems
Journal title
EUROPEAN HEART JOURNAL
ISSN journal
0195668X → ACNP
Volume
22
Issue
2
Year of publication
2001
Pages
153 - 164
Database
ISI
SICI code
0195-668X(200101)22:2<153:CELTTP>2.0.ZU;2-O
Abstract
Aims To describe the sequence of clinically apparent events causing readmis sion and antedating death, subsequent to a first-time hospital admission fo r heart failure, in order to give insights into the natural history and mec hanisms of progression of heart failure. Methods A national database of linked hospital discharge and mortality data for Scotland (population 5.1 million) was used. Patients with a first-time admission to hospital with heart failure in 1992 (index population) were i dentified and, using a record linkage system, hospital readmissions and the ir cause according to the hospital physician and deaths were recorded over the subsequent 3 years. A flowchart showing the sequence of events leading to death or recurrent admission was constructed. Results 12 640 patients had first-time admissions with heart failure in 199 2; their mean age was 74 years and 46.2% were men. A cohort of 2922 (23%) p atients died on their first admission. Among the remaining 9718 patients th ere were 22 747 readmissions and 4877 deaths over the subsequent 3 years; o nly 15% had neither event reported. Nine per cent of patients died without any readmission and a further 6% without a further readmission for cardiova scular reasons. A cohort of 5992 (61% of patients at risk) had at least one cardiovascular readmission and half of these had occurred within 6 months. Heart failure without a report of any cardiovascular precipitating event w as responsible for 37% (2188 patients) of first cardiovascular readmissions and of these patients approximately 12% had evidence of renal failure or a cute respiratory infection as possible triggers for readmission. Acute isch aemic events including myocardial infarction (19%), myocardial infarction a lone (8%) and atrial fibrillation (11%) were associated with a substantial number of first readmissions. First readmission precipitated by acute myoca rdial infarction was associated with a particularly poor prognosis (40% inp atient mortality). Conclusions Recurrent ischaemic events and atrial fibrillation may be the p redominant mechanisms leading to exacerbation of and progression of heart f ailure and death. A substantial proportion of readmissions appear related t o heart failure alone. Whether this reflects progressive ventricular remode lling leading to worsening heart failure or other unidentified mechanisms c annot be discerned from this data. (C) 2001 The European Society of Cardiol ogy.