Precipitating Clinical Factors, Heart Failure Characterization, and Outcomes in Patients Hospitalized With Heart Failure With Reduced, Borderline, and Preserved Ejection Fraction

John R. Kapoor*, Roger Kapoor, Christine Ju, Paul A. Heidenreich, Zubin J. Eapen, Adrian F. Hernandez, Javed Butler, Clyde W Yancy, Gregg C. Fonarow

*Corresponding author for this work

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)464-472
Number of pages9
JournalJACC: Heart Failure
Volume4
Issue number6
DOIs
StatePublished - Jun 1 2016

Fingerprint

Precipitating Factors
Heart Failure
Length of Stay
Pneumonia
Confidence Intervals
Medication Adherence
Odds Ratio
Hospital Mortality
Mortality
Hospitalization
Kidney
Pulmonary Edema
Weight Gain
Renal Insufficiency
Cardiac Arrhythmias
Ischemia
Databases
Guidelines
Hypertension

Keywords

  • Heart failure
  • Outcomes
  • Precipitating factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Kapoor, John R. ; Kapoor, Roger ; Ju, Christine ; Heidenreich, Paul A. ; Eapen, Zubin J. ; Hernandez, Adrian F. ; Butler, Javed ; Yancy, Clyde W ; Fonarow, Gregg C. / Precipitating Clinical Factors, Heart Failure Characterization, and Outcomes in Patients Hospitalized With Heart Failure With Reduced, Borderline, and Preserved Ejection Fraction. In: JACC: Heart Failure. 2016 ; Vol. 4, No. 6. pp. 464-472.
@article{26a663dff4204600b602429d057d445a,
title = "Precipitating Clinical Factors, Heart Failure Characterization, and Outcomes in Patients Hospitalized With Heart Failure With Reduced, Borderline, and Preserved Ejection Fraction",
abstract = "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.",
keywords = "Heart failure, Outcomes, Precipitating factors",
author = "Kapoor, {John R.} and Roger Kapoor and Christine Ju and Heidenreich, {Paul A.} and Eapen, {Zubin J.} and Hernandez, {Adrian F.} and Javed Butler and Yancy, {Clyde W} and Fonarow, {Gregg C.}",
year = "2016",
month = "6",
day = "1",
doi = "10.1016/j.jchf.2016.02.017",
language = "English (US)",
volume = "4",
pages = "464--472",
journal = "JACC: Heart Failure",
issn = "2213-1779",
publisher = "Elsevier BV",
number = "6",

}

Precipitating Clinical Factors, Heart Failure Characterization, and Outcomes in Patients Hospitalized With Heart Failure With Reduced, Borderline, and Preserved Ejection Fraction. / Kapoor, John R.; Kapoor, Roger; Ju, Christine; Heidenreich, Paul A.; Eapen, Zubin J.; Hernandez, Adrian F.; Butler, Javed; Yancy, Clyde W; Fonarow, Gregg C.

In: JACC: Heart Failure, Vol. 4, No. 6, 01.06.2016, p. 464-472.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Precipitating Clinical Factors, Heart Failure Characterization, and Outcomes in Patients Hospitalized With Heart Failure With Reduced, Borderline, and Preserved Ejection Fraction

AU - Kapoor, John R.

AU - Kapoor, Roger

AU - Ju, Christine

AU - Heidenreich, Paul A.

AU - Eapen, Zubin J.

AU - Hernandez, Adrian F.

AU - Butler, Javed

AU - Yancy, Clyde W

AU - Fonarow, Gregg C.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - 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.

AB - 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.

KW - Heart failure

KW - Outcomes

KW - Precipitating factors

UR - http://www.scopus.com/inward/record.url?scp=84977147320&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84977147320&partnerID=8YFLogxK

U2 - 10.1016/j.jchf.2016.02.017

DO - 10.1016/j.jchf.2016.02.017

M3 - Article

C2 - 27256749

AN - SCOPUS:84977147320

VL - 4

SP - 464

EP - 472

JO - JACC: Heart Failure

JF - JACC: Heart Failure

SN - 2213-1779

IS - 6

ER -