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Risk factors for rehospitalization in heart failure with preserved ejection fraction compared with reduced ejection fraction

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Abstract

Although there have been several studies regarding heart failure with preserved ejection fraction (HFpEF), investigations of the risk factors for readmission of Japanese patients with HFpEF remain scarce. Therefore, our goal was to identify the risk factors for readmission of Japanese patients with heart failure (HF), particularly those with HFpEF. We analyzed 310 patients who were hospitalized for the first time with HF. Preserved EF was defined EF ≥50 %, and reduced EF (rEF) was EF <50 %. The study endpoint was readmission for HF after discharge. Medical history, vital signs, electrocardiograms, chest radiographs, blood tests and echocardiograms were compared between patients with HFpEF and with HFrEF. Among the 142 patients who had HFpEF, 43 reached the endpoint within 1 year. Multivariate analysis revealed depression (HR: 7.185), high brain natriuretic peptide (BNP) levels at discharge (HR: 1.003), and dilated inferior vena cava (HR: 1.100) as independent risk factors for readmission. In contrast, 39 of the 168 patients with HFrEF reached the endpoint. Risk factors for readmission of HFrEF patients were low sodium (HR: 0.856), high blood urea nitrogen (HR: 1.045), high BNP levels at discharge (HR: 1.003) and absence of beta-blocker prescription (HR: 0.395). In conclusion, our study suggests that the predictors of HF readmission differ between HFpEF and HFrEF patients.

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References

  1. Tsuchihashi-Makaya M, Hamaguchi S, Kinugawa S, Yokota T, Goto D, Yokoshiki H, Kato N, Takeshita A, Tsutsui H (2009) Characteristics and outcomes of hospitalized patients with heart failure and reduced vs preserved ejection fraction. Report from Japanese cardiac registry of heart failure in cardiology (JCARE-CARD). Circ J 73:1893–1900

    Article  PubMed  Google Scholar 

  2. Shiba N, Watanabe J, Shinozaki T, Koseki Y, Sakuma M, Kagaya Y, Shirato K, The CHART investigators (2004) Analysis of chronic heart failure registry in the Tohoku district; third year follow-up. Circ J 68:427–434

    Article  PubMed  Google Scholar 

  3. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355:251–259

    Article  CAS  PubMed  Google Scholar 

  4. Steinberg BA, Zhao X, Heidenreich PA, Peterson ED, Bhatt DL, Cannon CP, Hernandez AF, Fonarow GC (2012) Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes. Circulation 126:65–75

    Article  PubMed  Google Scholar 

  5. Ather S, Chan W, Bozkurt B, Aguilar D, Ramasubbu K, Zachariah AA, Wehrens XHT, Deswal A (2012) Impact of noncardiac co-morbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll Cardiol 59:998–1005

    Article  PubMed  Google Scholar 

  6. Kitzman DW (2012) Outcomes in patients with heart failure with preserved ejection fraction. J Am Coll Cardiol 59:1006–1007

    Article  PubMed  Google Scholar 

  7. Lee DS, Gona P, Albano I, Larson MG, Benjamin EJ, Levy D, Kannel WB, Vasan RS (2011) A systematic assessment of causes of death after heart failure onset in the community: impact of age at death, time period, and left ventricular systolic dysfunction. Circ Heart Fail 4:36–43

    Article  PubMed Central  PubMed  Google Scholar 

  8. Marechaux S, Six-Carpentier MM, Bouabdallaoui N, Montaigne D, Bauchart JJ, Mouquet F, Auffray JL, Tourneau TL, Asseman P, LeJemtel TH, Ennezat PV (2011) Prognostic importance of co-morbidities in heart failure with preserved left ventricular ejection fraction. Heart Vessels 26:313–320

    Article  PubMed  Google Scholar 

  9. McKee PA, Castelli WP, McNamara PM, Kannel WB (1971) The natural history of congestive heart failure: the Framingham study. N Engl J Med 285:1441–1446

    Article  CAS  PubMed  Google Scholar 

  10. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, McDonagh T, Sechtem U, Bonet LA, Avraamides P, Ben Lamin HA, Brignole M, Coca A, Cowburn P, Dargie H, Elliott P, Flachskampf FA, Guida GF, Hardman S, Iung B, Merkely B, Mueller C, Nanas JN, Nielsen OW, Orn S, Parissis JT, Ponikowski P, ESC Committee for Practice Guidelines (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J 33:1787–1847

    Article  PubMed  Google Scholar 

  11. Radloff LS (1977) The CES-D scale; a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401

    Article  Google Scholar 

  12. O’Connor CM, Abraham WT, Albert NM, Clare R, Gattis Stough W, Gheorghiade M, Greenberg BH, Yancy CW, Young JB, Fonarow GC (2008) Predictors of mortality after discharge in patients with heart failure: an analysis from the organized program to initiate lifesaving treatment in hospitalized patients with heart failure (OPTIMIZE-HF). Am Heart J 156:662–673

    Article  PubMed  Google Scholar 

  13. Cleland JG, Tendera M, Adamus J, Freemantle N, Polonski Y, PEP-CHF investigators (2006) The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J 27:2338–2345

    Article  CAS  PubMed  Google Scholar 

  14. Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J, CHARM Investigators and Committees (2003) Effect of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-PRESERVED trial. Lancet 362:777–781

    Article  CAS  PubMed  Google Scholar 

  15. Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR, Anderson S, Donovan M, Iverson E, Staiger C, Ptaszynska A, I-PRESERVE Investigators (2008) Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med 359:2456–2467

    Article  CAS  PubMed  Google Scholar 

  16. Zhou J, Shi H, Zhang J, Lu Y, Fu M, Ge J (2010) Rationale and design of theβ-blocker in heart failure with normal left ventricular ejection fraction (β-PRESERVE) study. Eur J Heart Fail 12:181–185

    Article  CAS  PubMed  Google Scholar 

  17. Hori M, Kitabatake A, Tsutsui H, Okamoto H, Shirato K, Nagai R, Izumi T, Yokoyama H, Yasumura Y, Ishida Y, Matsuzaki M, Oki T, Sekiya M, J-DHF Program Committee (2005) Rationale and design of a randomized tiral to assess the effect of β-blocker in diastolic heart failure: Japanese diastolic heart failure study (J-DHF). J Card Fail 11:542–547

    Article  PubMed  Google Scholar 

  18. Konishi M, Haraguchi G, Ohigashi H, Sasaoka T, Yoshikawa S, Inagaki H, Ashikaga T, Isobe M (2012) Progression of hyponatremia is associated with increased cardiac mortality in patients hospitalized for acute decompensated heart failure. J Card Fail 8:620–625

    Article  Google Scholar 

  19. Klein L, Massie BM, Leimberger JD, O’Connor CM, Plna IL, Adams KF Jr, Cliff RM, Gheorghiade M (2008) Admission or change in renal function during hospitalization for worsening heart failure predict post discharge survival: results from the outcomes of a progressive trial of intravenous milrinone for exacerbations of chronic heart failure (OPTIME-CHF). Circ Heart Fail 1:25–33

    Article  CAS  PubMed  Google Scholar 

  20. Kociol RD, Horton JR, Fonarow FC, Reyes EM, Shaw LK, O’Connor CM, Felker GM, Hernandez AF (2011) Admission, discharge, or change in b-type natriuretic peptide and long-term outcomes. Data from organized program to initiate lifesaving treatment in hospitalized patients with heart failure (OPTIMIZE-HF) linked to medicare claims. Circ Heart Fail 4:628–636

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Packer M, Coats AJ, Fowler MB, Katus HA, Krum H, Mohacsi P, Rouleau JL, Tendera M, Castaigne A, Roecker EB, Schultz MK, Demets DL (2001) Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 344:1651–1658

    Article  CAS  PubMed  Google Scholar 

  22. Kallistratos MS, Poulimenos LE, Pavlidis AN, Dritsas A, Laoutaris ID, Manolis AJ, Cokkinos DV (2012) Prognostic significance of blood pressure response to exercise in patients with systolic heart failure. Heart Vessels 27:46–52

    Article  PubMed  Google Scholar 

  23. Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ (2006) Depression in heart failure. A meta-analysis review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol 48:1527–1537

    Article  PubMed  Google Scholar 

  24. Joynt KE, Whellan DJ, O’Connor CM (2004) Why is depression bad for the failing heart? A review of the mechanistic relationship between depression and heart failure. J Card Fail 10:258–271

    Article  PubMed  Google Scholar 

  25. Kato N, Kinugawa K, Shiga T, Hatano M, Takeda N, Imai Y, Watanabe M, Yao A, Hirata Y, Kazuma K, Nagai R (2012) Depressive symptoms are common and associated with adverse clinical outcomes in heart failure with reduced and preserved ejection fraction. J Cardiol 60:23–30

    Article  PubMed  Google Scholar 

  26. Lam CS, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM (2009) Pulmonary hypertension in heart failure with preserved ejection fraction. A community-based study. J Am Coll Cardiol 53:1119–1126

    Article  PubMed Central  PubMed  Google Scholar 

  27. Nath J, Vacek JL, Heidenreich PA (2006) A dilated inferior vena cava is a marker of poor survival. Am Heart J 151:730–735

    Article  PubMed  Google Scholar 

  28. Tanaka Y, Taniguchi M, Sugawara M, Nobusada S, Kusano K, Akagi T, Ito H (2013) Evaluation of exercise capacity using wave intensity in chronic heart failure with normal ejection fraction. Heart Vessels 28:179–187

    Article  Google Scholar 

  29. Cournot M, Mourre F, Castel F, Ferrieres J, Destrac S (2008) Optimization of the use of b-type natriuretic peptide levels for risk stratification at discharge in elderly patients with decompensated heart failure. Am Heart J 155:986–991

    Article  CAS  PubMed  Google Scholar 

  30. Valle R, Aspromonte N, Feola M, Milli M, Canali C, Giovinazzo P, Carbonieri E, Ceci V, Cerisano S, Barro S, Milani L (2005) B-type natriuretic peptide can predict the medium-term risk in patients with acute heart failure and preserved systolic function. J Card Fail 11:498–503

    Article  CAS  PubMed  Google Scholar 

  31. West R, Liang L, Fonarow GC, Kociol R, Mills RM, O’Connor CM, Hernandez F (2011) Characteristics of heart failure patients with preserved ejection fraction: a comparison between ADHERE-US registry and ADHERE-international registry. Eur J Heart Fail 13:945–952

    Article  PubMed Central  PubMed  Google Scholar 

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The authors have no potential conflicts of interests to disclose.

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Authors and Affiliations

  1. Department of Cardiology, Kameda General Hospital, Kamogawa, Japan

    Masahiko Setoguchi & Yuji Hashimoto

  2. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Masahiko Setoguchi, Taro Sasaoka, Takashi Ashikaga & Mitsuaki Isobe

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  1. Masahiko Setoguchi
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  2. Yuji Hashimoto
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  3. Taro Sasaoka
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  4. Takashi Ashikaga
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  5. Mitsuaki Isobe
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Correspondence to Masahiko Setoguchi.

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Setoguchi, M., Hashimoto, Y., Sasaoka, T. et al. Risk factors for rehospitalization in heart failure with preserved ejection fraction compared with reduced ejection fraction. Heart Vessels 30, 595–603 (2015). https://doi.org/10.1007/s00380-014-0532-5

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  • DOI: https://doi.org/10.1007/s00380-014-0532-5

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