Hospitalization linked to increased mortality in heart failure patients

Patients with heart failure are at increased risk of death if they are hospitalized for worsening heart failure symptoms, according to new research from UAB (University of Alabama at Birmingham).

The findings, published this month in the Journal of Cardiac Failure, suggest that a new emphasis on avoiding the need to hospitalize heart failure patients is required in medicine.

“Our findings show that hospitalization due to worsening heart failure, often thought to be due to non-adherence to regimens of salt or fluid restriction, or prescribed medications, may also represent progression of disease,” said Ali Ahmed, M.D., MPH, associate professor in the division of gerontology, geriatrics and palliative care medicine and director of UAB's Geriatric Heart Failure Clinic and the study's lead investigator. “New strategies are needed to better manage heart failure before the disease progresses to a point where hospitalization is required.”

Hospitalization due to heart failure is the leading cause of hospitalization among older adults, and with the aging of the baby boomers, the number of heart failure patients and heart failure hospitalizations are projected to double over the next couple of decades.

Ahmed's group studied 7,788 patients enrolled in the Digitalis Investigation Group, a large clinical trial of heart failure patients conducted in 302 centers in the United States and Canada from 1991-1993. The study was funded by the National Heart, Lung and Blood Institute (NHLBI), one of the National Institutes of Health.

Ahmed and colleagues found that compared to patients who had no hospitalization due to worsening heart failure during two years after randomization, those with heart failure hospitalization had about 150 percent increase in the risk of subsequent death from all causes (occurring after the first two years). The risk of death due to cardiovascular causes increased by 188 percent and that due to progressive heart failure increased by 422 percent.

“Clinicians should focus on the prevention of heart failure hospitalization in ambulatory chronic heart failure patients and once a heart failure patient is hospitalized, on improving post-discharge outcomes including re-hospitalization and mortality,” says Ahmed. “This could be achieved by the use of evidence-based therapy, patient education, and research to develop new strategies to prevent hospital admission and improve post-discharge outcomes.”

Dr. Ahmed's co-researchers were Richard M. Allman, M.D., and Louis Dell'Italia, M.D., from UAB; Gregg Fonarow, M.D., from the University of California in Los Angeles, Los Angeles; Thomas E. Love, Ph.D. from the Case Western University, Cleveland; Faiez Zannad, M.D, Ph.D., from University Henri Poincare´, Nancy, France; Michel White, M.D., from the Montreal Heart Institute, Montreal, Canada, and Mihai Gheorghiade, M.D., from Northwestern University, Chicago.