Individual Trajectories of Health Status During the First Year of Discharge From Hospitalization for Heart Failure and Their Associations With Death in the Following Years

Abstract

Background Improving health status is one of the major goals in the management of heart failure (HF). However, little is known about the long-term individual trajectories of health status in patients with acute HF after discharge. Methods and Results We enrolled 2328 patients hospitalized for HF from 51 hospitals prospectively and measured their health status via the Kansas City Cardiomyopathy Questionnaire-12 at admission and 1, 6, and 12 months after discharge, respectively. The median age of the patients included was 66 years, and 63.3% were men. Six patterns of Kansas City Cardiomyopathy Questionnaire-12 trajectories were identified by a latent class trajectory model: persistently good (34.0%), rapidly improving (35.5%), slowly improving (10.4%), moderately regressing (7.4%), severely regressing (7.5%), and persistently poor (5.3%). Advanced age, decompensated chronic HF, HF with mildly reduced ejection fraction, HF with preserved ejection fraction, depression symptoms, cognitive impairment, and each additional HF rehospitalization within 1 year of discharge were associated with unfavorable health status (moderately regressing, severely regressing, and persistently poor) (P<0.05). Compared with the pattern of persistently good, slowly improving (hazard ratio [HR], 1.50 [95% CI, 1.06-2.12]), moderately regressing (HR, 1.92 [1.43-2.58]), severely regressing (HR, 2.26 [1.54-3.31]), and persistently poor (HR, 2.34 [1.55-3.53]) were associated with increased risks of all-cause death. Conclusions One-fifth of 1-year survivors after hospitalization for HF experienced unfavorable health status trajectories and had a substantially increased risk of death during the following years. Our findings help inform the understanding of disease progression from a patient perception perspective and its relationship with long-term survival. Registration URL: https://www.clinicaltrials.gov; unique identifier: NCT02878811.

Keywords: acute heart failure; death; health status; prognosis.

Figure 1. Six patterns of health status (measured by KCCQ‐12) trajectories identified by latent class trajectory model.

The shaded areas represent 95% CIs. KCCQ‐12 indicates Kansas City Cardiomyopathy Questionnaire‐12.

Figure 2. Factors associated with patterns of unfavorable health status by logistic regression.

Small black squares are odds ratios, and their horizontal lines indicate the corresponding 95% CIs. ACEI indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin‐receptor blocker; CCB, calcium channel blocker; CHD, coronary heart disease; COPD, chronic obstructive pulmonary disease; DCHF, decompensated chronic heart failure; HF, heart failure; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; LVEF, left ventricular ejection fraction; NT‐proBNP, N‐terminal pro‐B‐type natriuretic peptide; OR, odds ratio; SERF, socioeconomic risk factor; and VHD, valvular heart disease.

Figure 3. Cumulative incidence curves for all‐cause death (A) and cardiovascular death (B) by patterns of health status trajectories.

Differences in cumulative incidences across different trajectory patterns were evaluated using log‐rank tests. The red lines, green lines, golden lines, black lines, orange lines, and purple lines represent the cumulative incidences of persistently poor, severely regressing, moderately regressing, slowly improving, rapidly improving, and persistently good groups, respectively.

Figure 4. Risk of deaths in different patterns of health status trajectories by Cox proportional hazards model and Fine–Gray model.

Adjusting for age, sex, number of socioeconomic risk factors, drinking, exercising, new‐onset HF/decompensated chronic heart failure, left ventricular ejection fraction class, comorbidities (coronary heart disease, hypertension, atrial fibrillation, diabetes, reduced renal function, chronic obstructive pulmonary disease, stroke, anemia, valvular heart disease, and cancer), systolic blood pressure at admission, N‐terminal pro‐B‐type natriuretic peptide at admission, serum sodium at admission, Kansas City Cardiomyopathy Questionnaire−12 score at admission, depression symptoms before discharge, cognitive impairment before discharge, postdischarge medication, and the number of heart failure rehospitalizations within 1 year of discharge. Small black squares are hazard ratios, and their horizontal lines indicate the corresponding 95% CIs. HR indicates hazard ratio.