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Background: In severe heart failure, hospitalizations are high-risk events. However, their prognostic role, especially regarding clinical, neurohormonal, and hemodynamic factors, is not well-described.
Methods: We analyzed the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial database. Hospitalizations in the past 12 months (PH12) were self-reported. Primary endpoint was days well, not dead or hospitalized, (transplant/LVAD count as dead or well) by 180 days. Models were adjusted for ESCAPE Discharge Risk Score and, in a subset, PCWP and CO.
Results: In this cohort (N=420, age 56±14 y, 74% male, 49% ischemic etiology, EF 19±7%) tertiles of PH12 were 1 or less (T1); 2 to 3 (T2); and 4 or more (T3). Days well (transplant/LVAD, dead) were 136±58, 133±54, and 115±64; days well (transplant/LVAD, well) were 143±53, 140±48, and 123±59 across tertiles (Figure). Those in T3 were at higher risk for fewer days well than those in T1 where transplants/LVADs count as dead or well (HR 1.8, 95% CI 1.4-2.4, P<0.001; and HR 1.9, 95% CI 1.4-2.4, P<0.001; respectively). These associations persisted with added adjustment for hemodynamics (HR 1.8, 95% CI 1.1-2.7, P=0.01; and HR 1.7, 95% CI 1.1-2.7, P=0.01; respectively).
Conclusions: The number of hospitalizations in severe heart failure is independently prognostic of more traditional and hemodynamic risk factors. This highlights the importance of this simple question in the risk-stratification of these patients.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Heart Failure: Evaluating Strategies to Prevent Readmissions
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1163-285
- 2017 American College of Cardiology Foundation