Predictors of Decreased Morbidity and Hospitalization After Incident Heart Failure

Desai and Stevenson describe a three-phase topology of heart failure (HF). First is the “transition phase,” a period of heightened risk for readmission/adverse events following an index hospitalization for acute decompensated HF. Second is the “plateau phase,” a time of chronic, stable HF. Third is the “Phase of Palliation and Priorities,” representing advanced HF, frequent hospitalizations, and heightened mortality. As a fellow caring for patients hospitalized with HF, I have observed through histories and chart reviews that many patients with HF stabilize on a medical HF regimen, achieving many years free from recurrent hospitalization (a long “plateau phase”). Others, despite optimal medical therapy, achieve a rather attenuated “plateau phase”, transitioning rapidly into phase three. Why does this discrepancy in HF trajectory between patients exist? The Cardiovascular Lifetime Risk Pooling Project is a large individual-level pooled dataset comprised of 18 US community-based cohorts housed at Northwestern. Conveniently, adjudicated HF outcomes exist within these large cohorts in addition to detailed clinical, socioeconomic, diagnostic, and biochemical data on each of the participating subjects. My aim is to identify predictors of a prolonged “plateau phase” after a diagnosis of incident HF. I hypothesize that in addition to treatment with evidence-based therapies, there are variables occurring antecedent to the incident HF and during the early part “plateau phase” predictive of HF events. Better characterization of these factors will facilitate the identification of patients at high risk for hospitalization, allowing for earlier and more aggressive interventions and more informed counseling of patients about prognosis