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. 2021 Jun;8(3):2120-2132.
doi: 10.1002/ehf2.13293. Epub 2021 Mar 10.

Impact of readmissions on octogenarians with heart failure with preserved ejection fraction: PURSUIT-HFpEF registry

Masami Nishino  1 , Masamichi Yano  1 , Kohei Ukita  1 , Akito Kawamura  1 , Hitoshi Nakamura  1 , Yutaka Matsuhiro  1 , Koji Yasumoto  1 , Masaki Tsuda  1 , Naotaka Okamoto  1 , Akihiro Tanaka  1 , Yasuharu Matsunaga-Lee  1 , Yasuyuki Egami  1 , Ryu Shutta  1 , Jun Tanouchi  1 , Takahisa Yamada  2 , Yoshio Yasumura  3 , Shunsuke Tamaki  2 , Takaharu Hayashi  4 , Akito Nakagawa  3   5 , Yusuke Nakagawa  6 , Shinichiro Suna  7   8 , Daisaku Nakatani  7   8 , Shungo Hikoso  7 , Yasushi Sakata  7 ; Osaka CardioVascular Conference (OCVC)-Heart Failure Investigators
Affiliations

Impact of readmissions on octogenarians with heart failure with preserved ejection fraction: PURSUIT-HFpEF registry

Masami Nishino et al. ESC Heart Fail. 2021 Jun.

Abstract

Aims: Heart failure (HF) readmissions with preserved ejection fraction (HFpEF) are increasing in the elderly, which is a major socioeconomic problem. We investigated the clinical impact of HF readmissions (HFR) on octogenarians with HFpEF.

Methods and results: We enrolled consecutive octogenarians (≥80 years old) from June 2016 to February 2020 in PURSUIT-HFpEF registry. We divided them into HFR group readmitted for HF during the follow-up period and non-HF readmission (non-HFR) group. We evaluated the impact of HFR on all-cause mortality, cardiac death, and quality of life (QOL). Additionally, we evaluated the factors at discharge correlated with HFR. HFR group comprised 116 patients (21.4%). Among all-cause deaths, 40 patients suffered cardiac deaths (48.2%). The Kaplan-Meier analysis revealed a similar prognosis between HFR and non-HFR groups as well as similar incidences of HF deaths. The QOL scores had significantly deteriorated by 1 year later in the HFR group (0.71 ± 0.19 vs. 0.59 ± 0.21, P < 0.001), while it was similar at 1 year in the non-HFR group. In the multivariate analysis, diabetes mellitus (DM) (P = 0.019), N-terminal pro-B-type natriuretic peptide (NT-pro BNP) levels ≥ 1611 pg/mL (P < 0.001), and serum albumin level ≤ 3.7 g/dL (P = 0.011) were useful markers for HFR in octogenarians.

Conclusions: In octogenarians with HFpEF, HF readmission was not directly correlated with the prognosis but was well correlated with the QOL. Close follow-up is essential to decrease HFR of octogenarians with HFpEF with DM, high NT-pro BNP (≥1611 pg/mL) and low albumin (≤3.7 g/dL) levels at discharge.

Keywords: Albumin; Diabetes mellitus; Heart failure with preserved ejection fraction; N-terminal pro-B-type natriuretic peptide; Octogenarian.

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Conflict of interest statement

Daisaku Nakatani has received honoraria from Roche Diagnostics. Shungo Hikoso has received personal fees from the Daiichi Sankyo Company, Bayer, Astellas Pharma, Pfizer Pharmaceuticals, and Boehringer Ingelheim Japan and received grants from Roche Diagnostics, FUJIFILM Toyama Chemical, and Actelion Pharmaceuticals. Yasushi Sakata received personal fees from Otsuka Pharmaceutical, Ono Pharmaceutical, Daiichi Sankyo Company, Mitsubishi Tanabe Pharma Corporation, and Actelion Pharmaceuticals and received grants from Roche Diagnostic, FUJIFILM Toyama Chemical, Abbott Medical Japan, Otsuka Pharmaceutical, Daiichi Sankyo Company, Mitsubishi Tanabe Pharma Corporation, and Biotronik. The other authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram for the inclusion of the study patients. HFR, heart failure readmission.
Figure 2
Figure 2
All‐cause mortality (A) and cardiac death (B) between the HFR group and non‐HFR group. HFR indicates a heart failure readmission. HFR, heart failure readmission.
Figure 3
Figure 3
Distribution of cases for cardiac deaths (A) and non‐cardiac deaths (B) in HFR and non‐HFR groups. Arryth SCD indicates arrhythmia/sudden cardiac death; CVD, cerebrovascular disease; HF, heart failure; MI, myocardial infarction; the other abbreviations are the same as in Figure 2. HFR, heart failure readmission.
Figure 4
Figure 4
Comparison between the QOL scores at discharge and those at 1 year. The QOL scores were significantly deteriorated by 1 year later in the HFR group (0.71 ± 0.19 vs. 0.59 ± 0.21, P < 0.001) (A), but there were no significant differences in the QOL scores at 1 year in the non‐HFR group (0.69 ± 0.23 vs. 0.71 ± 0.21, P = 0.117) (B). QOL indicates quality of life. HFR, heart failure readmission.
See this image and copyright information in PMC

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