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. 2023 Sep 20;12(18):6082.
doi: 10.3390/jcm12186082.

The Worsening of Heart Failure with Reduced Ejection Fraction: The Impact of the Number of Hospital Admissions in a Cohort of Patients

Jorge Perea-Armijo  1   2 , José López-Aguilera  1   2 , Rafael González-Manzanares  1   2 , Cristina Pericet-Rodriguez  1   2 , Juan Carlos Castillo-Domínguez  1   2 , Gloria Heredia-Campos  1   2 , Álvaro Roldán-Guerra  1   2 , Cristina Urbano-Sánchez  1   2 , Lucas Barreiro-Mesa  1   2 , Nerea Aguayo-Caño  1   2 , Mónica Delgado-Ortega  1   2 , Manuel Crespín-Crespín  1   2 , Martín Ruiz-Ortiz  1   2 , Dolores Mesa-Rubio  1   2 , Manuel Pan-Álvarez Osorio  1   2 , Manuel Anguita-Sánchez  1   2
Affiliations

The Worsening of Heart Failure with Reduced Ejection Fraction: The Impact of the Number of Hospital Admissions in a Cohort of Patients

Jorge Perea-Armijo et al. J Clin Med. .

Abstract

Background: Worsening heart failure (WFH) includes heart failure (HF) hospitalisation, representing a strong predictor of mortality in patients with heart failure with reduced ejection fraction (HFrEF). However, there is little evidence analysing the impact of the number of previous HF admissions. Our main objective was to analyse the clinical profile according to the number of previous admissions for HF and its prognostic impact in the medium and long term.

Methods: A retrospective study of a cohort of patients with HFrEF, classified according to previous admissions: cohort-1 (0-1 previous admission) and cohort-2 (≥2 previous admissions). Clinical, echocardiographic and therapeutic variables were analysed, and the medium- and long-term impacts in terms of hospital readmissions and cardiovascular mortality were assessed. A total of 406 patients were analysed.

Results: The mean age was 67.3 ± 12.6 years, with male predominance (73.9%). Some 88.9% (361 patients) were included in cohort-1, and 45 patients (11.1%) were included in cohort-2. Cohort-2 had a higher proportion of atrial fibrillation (49.9% vs. 73.3%; p = 0.003), chronic kidney disease (36.3% vs. 82.2%; p < 0.001), and anaemia (28.8% vs. 53.3%; p = 0.001). Despite having similar baseline ventricular structural parameters, cohort-1 showed better reverse remodelling. With a median follow-up of 60 months, cohort-1 had longer survival free of hospital readmissions for HF (37.5% vs. 92%; p < 0.001) and cardiovascular mortality (26.2% vs. 71.9%; p < 0.001), with differences from the first month.

Conclusions: Patients with HFrEF and ≥2 previous admissions for HF have a higher proportion of comorbidities. These patients are associated with worse reverse remodelling and worse medium- and long-term prognoses from the early stages, wherein early identification is essential for close follow-up and optimal intensive treatment.

Keywords: hospital admission; mortality; prognosis; reduced LVEF; worsening of heart failure.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
This figure shows the study design and the main results of comorbidities, left ventricular remodelling, and the prognosis of both cohorts. In blue are the results of cohort 1, and in red are the results of cohort 2.
Figure 2
Figure 2
Kaplan–Meier curve of time to readmission for heart failure (A) and cardiovascular mortality (B) in patients with heart failure and a history of ≤ 1 and ≥2 admissions for HF.
See this image and copyright information in PMC

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