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. 2020 Aug;7(4):1688-1699.
doi: 10.1002/ehf2.12727. Epub 2020 May 8.

Recurrent heart failure hospitalizations are associated with increased cardiovascular mortality in patients with heart failure in Clinical Practice Research Datalink

Raquel Lahoz  1 , Ailís Fagan  2 , Martin McSharry  2 , Clare Proudfoot  1 , Stefano Corda  1 , Rachel Studer  1
Affiliations

Recurrent heart failure hospitalizations are associated with increased cardiovascular mortality in patients with heart failure in Clinical Practice Research Datalink

Raquel Lahoz et al. ESC Heart Fail. 2020 Aug.

Abstract

Aims: Heart failure (HF) is a leading cause of hospitalization and is associated with high morbidity and mortality post-diagnosis. Here, we examined the impact of recurrent HF hospitalization (HFH) on cardiovascular (CV) and all-cause mortality among HF patients.

Methods and results: Adult HF patients identified in the Clinical Practice Research Datalink with a first (index) hospitalization due to HF recorded in the Hospital Episode Statistics data set from January 2010 to December 2014 were included. Patients were followed up until death or end of study (December 2017). CV mortality as primary and as any reported cause and all-cause mortality were evaluated. An extended Cox regression model was used for reporting adjusted relative CV mortality rates for time-dependent recurrent HFHs. Overall, 8603 HF patients with an index hospitalization were included, providing 15 964 patient-years of follow-up. Patients were relatively old (median age: 80 years) and were mostly male (54.6%), with main co-morbidities being hypertension and atrial fibrillation. Recurrent HFHs occurred one, two, three, and more than four times in 1561 (18.2%), 518 (6.02%), 206 (2.4%), and 153 (1.8%) patients, respectively. The median time to mortality was 215 (38-664) days for 50.8% of patients who died for any cause during the study period and 139 (27-531) days for 31.3% who died with CV reasons as primary cause. Compared with those of patients without recurrent HFHs, the adjusted hazard ratios (95% CI) for CV mortality as primary cause were 2.65 (2.35-2.99), 3.69 (3.06-4.43), 5.82 (4.48-7.58), and 5.95 (4.40-8.05) for those with one, two, three, and more than four recurrent HFHs.

Conclusions: There is a strong association between recurrent HFH and CV mortality, with the risk increasing progressively with each recurrent HFH.

Keywords: Heart failure; Mortality/survival.

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Conflict of interest statement

Raquel Lahoz, Clare Proudfoot, Stefano Corda, and Rachel Studer are employees of Novartis Pharma AG, Basel. Ailís Fagan is an employee of Novartis Ireland Limited, Dublin. Martin McSharry was an employee of Novartis Ireland Limited, Dublin, at the time of conduct of this study.

Figures

Figure 1
Figure 1
Overview of study design. Note: Identification period: patients with at least one heart failure hospitalization (HFH) were identified during this time. Index date: date of first HFH during the identification period. Pre‐index period: 4 years prior to index date. During this time, patients had no HFH (‘clean' period). Follow‐up period: until study end (31 Dec 2017), death, and transfer‐out date (whichever event was earliest).
Figure 2
Figure 2
Patient selection process. Note: CPRD, Clinical Practice Research Datalink; HES, Hospital Episodes Statistics; HF, heart failure; ICD‐10: International Classification of Diseases, 10th Edition; ONS, Office of National Statistics.
Figure 3
Figure 3
Annualized mortality rates according to number of recurrent HF hospitalizations. Note: Error bars represent 95% CI range. CI, confidence interval; CV, cardiovascular; HF, heart failure.
Figure 4
Figure 4
Impact of covariates on the association of recurrent HFH and all‐cause mortality. Note: #Time‐dependent covariate. Covariates highlighted in green were associated with a significantly reduced risk of mortality, while those highlighted in light red colour were associated with a significantly increased risk of mortality. ACEis, angiotensin‐converting enzyme inhibitors; ARB, angiotensin II receptor blockers; CI, confidence interval; CRT, cardiac resynchronization therapy; CV, cardiovascular; eGFR, estimated glomerular filtration rate; HR, hazard ratio.
Figure 5
Figure 5
Impact of covariates on the association of recurrent HFH and CV mortality as primary cause. Note: #Time‐dependent covariate. Covariates highlighted in green were associated with a significantly reduced risk of mortality, while those highlighted in light red colour were associated with a significantly increased risk of mortality; ACEis, angiotensin‐converting enzyme inhibitors; ARB, angiotensin II receptor blockers; CI, confidence interval; CRT, cardiac resynchronization therapy; CV, cardiovascular; eGFR, estimated glomerular filtration rate; HR, hazard ratio.
Figure 6
Figure 6
Impact of covariates on the association of recurrent HFH and CV mortality as any cause. Note: #Time‐dependent covariate. Covariates highlighted in green were associated with a significantly reduced risk of mortality, while those highlighted in light red colour were associated with a significantly increased risk of mortality. ACEis, angiotensin‐converting enzyme inhibitors; ARB, angiotensin II receptor blockers; CI, confidence interval; CRT, cardiac resynchronization therapy; CV, cardiovascular; eGFR, estimated glomerular filtration rate; HR, hazard ratio.
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References

    1. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker‐Collo S, Barrero LH, Bartels DH, Basanez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabe E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan‐Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng AT, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere‐Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz‐Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fevre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gosselin R, Grainger R, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Ma J, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill NN, McGrath JJ, Medina‐Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi‐Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KM, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez‐Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA 3rd, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leon FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez‐Riera L, Sanman E, Schwebel DC, Scott JG, Segui‐Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJ, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams SR, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AK, Zheng ZJ, Zonies D, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2163–2196. - PMC - PubMed
    1. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M, Nodari S, Lam CSP, Sato N, Shah AN, Gheorghiade M. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 2014; 63: 1123–1133. - PubMed
    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez‐Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force M, Document R . 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016; 18: 891–975. - PubMed
    1. Cowie MR. The heart failure epidemic: a UK perspective. Echo Res Pract 2017; 4: R15–R20. - PMC - PubMed
    1. Braunschweig F, Cowie MR, Auricchio A. What are the costs of heart failure? Europace 2011; 13: ii13–ii17. - PubMed

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