Factors associated with prolonged hospitalization, readmission, and death in elderly heart failure patients in western Romania

Istvan Gyalai-Korpos,1,2 Oana Ancusa,1,2 Tiberiu Dragomir,1,2 Mirela Cleopatra Tomescu,1,2 Iosif Marincu1,3 1University of Medicine and Pharmacy, 2Cardiology Department, City Hospital, 3Department of Epidemiology and Infectious Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara,...

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Autores principales:	Gyalai-Korpos I, Ancusa O, Dragomir T, Tomescu MC, Marincu I
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2015
Materias:	elderly heart failure reduced ejection fraction outcome predictors Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/85fabce5fcfd4d048e012dc4622df656
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spelling	oai:doaj.org-article:85fabce5fcfd4d048e012dc4622df6562021-12-02T01:09:21ZFactors associated with prolonged hospitalization, readmission, and death in elderly heart failure patients in western Romania1178-1998https://doaj.org/article/85fabce5fcfd4d048e012dc4622df6562015-03-01T00:00:00Zhttps://www.dovepress.com/factors-associated-with-prolonged-hospitalization-readmission-and-deat-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Istvan Gyalai-Korpos,1,2 Oana Ancusa,1,2 Tiberiu Dragomir,1,2 Mirela Cleopatra Tomescu,1,2 Iosif Marincu1,3 1University of Medicine and Pharmacy, 2Cardiology Department, City Hospital, 3Department of Epidemiology and Infectious Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Purpose: The purpose of this prospective study was to identify factors associated with prolonged hospitalization, readmission, and death in elderly patients presenting heart failure with reduced ejection fraction.Patients and methods: All consecutive patients aged ≥65 years discharged with a diagnosis of acute new-onset heart failure and a left ventricular ejection fraction (LVEF) ≤45% were included and followed up for 1 year. The variables associated with outcomes were analyzed in univariate and multivariate logistic regression. For the independent predictors identified by multivariate analysis, receiver operating characteristic (ROC) analysis was performed.Results: A total of 71 patients were included in the study. The patient mean age was 72.5 years, 50% were female, and the mean LVEF was 31.25%±5.76%. In all, 34 (48%) patients experienced prolonged hospitalization, and this was independently associated with patients who were living in a rural area (P=0.005), those with a New York Heart Association functional class of 4 (P<0.001), the presence of comorbidities (P=0.023), chronic obstructive pulmonary disease (COPD) infectious exacerbation (P<0.001), and chronic kidney disease (P=0.025). In the multivariate analysis, only COPD infectious exacerbation was independently associated with prolonged hospitalization (P=0.003). A total 19 patients (27%) experienced readmissions during the 1-year follow up, of which 12 (17%) had cardiovascular causes and seven (10%) had noncardiovascular causes. The following independent variables associated with rehospitalizations were outlined in the univariate analysis: infections (P<0.020); COPD infectious exacerbation (P=0.015); one or more comorbidity (P<0.0001); and prolonged baseline hospitalization (P<0.0001). During the multivariate analysis, it was found that the independent predictors of readmissions were the presence of comorbidities (P<0.001) and prolonged baseline hospitalization (P<0.01). The 1-year mortality rate was 9.8%, with no significant difference between cardiovascular (5.6%) and noncardiovascular (4.2%) deaths. The only independent predictive variable for mortality was a New York Heart Association NYHA functional class 4 at baseline hospitalization (P=0.001).Conclusion: Elderly patients are at high risk for prolonged hospitalization, readmission, and death following a first hospitalization for heart failure with reduced ejection fraction. The most powerful predictors for outcomes are the severity of heart failure, the presence of comorbidities, and prolonged hospitalization at baseline. Keywords: reduced ejection fraction, outcome predictors, comorbidities, acute new onset heart failure, left ventricular ejection fractionGyalai-Korpos IAncusa ODragomir TTomescu MCMarincu IDove Medical Pressarticleelderlyheart failurereduced ejection fractionoutcome predictorsGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 10, Pp 561-568 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	elderly heart failure reduced ejection fraction outcome predictors Geriatrics RC952-954.6
spellingShingle	elderly heart failure reduced ejection fraction outcome predictors Geriatrics RC952-954.6 Gyalai-Korpos I Ancusa O Dragomir T Tomescu MC Marincu I Factors associated with prolonged hospitalization, readmission, and death in elderly heart failure patients in western Romania
description	Istvan Gyalai-Korpos,1,2 Oana Ancusa,1,2 Tiberiu Dragomir,1,2 Mirela Cleopatra Tomescu,1,2 Iosif Marincu1,3 1University of Medicine and Pharmacy, 2Cardiology Department, City Hospital, 3Department of Epidemiology and Infectious Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Purpose: The purpose of this prospective study was to identify factors associated with prolonged hospitalization, readmission, and death in elderly patients presenting heart failure with reduced ejection fraction.Patients and methods: All consecutive patients aged ≥65 years discharged with a diagnosis of acute new-onset heart failure and a left ventricular ejection fraction (LVEF) ≤45% were included and followed up for 1 year. The variables associated with outcomes were analyzed in univariate and multivariate logistic regression. For the independent predictors identified by multivariate analysis, receiver operating characteristic (ROC) analysis was performed.Results: A total of 71 patients were included in the study. The patient mean age was 72.5 years, 50% were female, and the mean LVEF was 31.25%±5.76%. In all, 34 (48%) patients experienced prolonged hospitalization, and this was independently associated with patients who were living in a rural area (P=0.005), those with a New York Heart Association functional class of 4 (P<0.001), the presence of comorbidities (P=0.023), chronic obstructive pulmonary disease (COPD) infectious exacerbation (P<0.001), and chronic kidney disease (P=0.025). In the multivariate analysis, only COPD infectious exacerbation was independently associated with prolonged hospitalization (P=0.003). A total 19 patients (27%) experienced readmissions during the 1-year follow up, of which 12 (17%) had cardiovascular causes and seven (10%) had noncardiovascular causes. The following independent variables associated with rehospitalizations were outlined in the univariate analysis: infections (P<0.020); COPD infectious exacerbation (P=0.015); one or more comorbidity (P<0.0001); and prolonged baseline hospitalization (P<0.0001). During the multivariate analysis, it was found that the independent predictors of readmissions were the presence of comorbidities (P<0.001) and prolonged baseline hospitalization (P<0.01). The 1-year mortality rate was 9.8%, with no significant difference between cardiovascular (5.6%) and noncardiovascular (4.2%) deaths. The only independent predictive variable for mortality was a New York Heart Association NYHA functional class 4 at baseline hospitalization (P=0.001).Conclusion: Elderly patients are at high risk for prolonged hospitalization, readmission, and death following a first hospitalization for heart failure with reduced ejection fraction. The most powerful predictors for outcomes are the severity of heart failure, the presence of comorbidities, and prolonged hospitalization at baseline. Keywords: reduced ejection fraction, outcome predictors, comorbidities, acute new onset heart failure, left ventricular ejection fraction
format	article
author	Gyalai-Korpos I Ancusa O Dragomir T Tomescu MC Marincu I
author_facet	Gyalai-Korpos I Ancusa O Dragomir T Tomescu MC Marincu I
author_sort	Gyalai-Korpos I
title	Factors associated with prolonged hospitalization, readmission, and death in elderly heart failure patients in western Romania
title_short	Factors associated with prolonged hospitalization, readmission, and death in elderly heart failure patients in western Romania
title_full	Factors associated with prolonged hospitalization, readmission, and death in elderly heart failure patients in western Romania
title_fullStr	Factors associated with prolonged hospitalization, readmission, and death in elderly heart failure patients in western Romania
title_full_unstemmed	Factors associated with prolonged hospitalization, readmission, and death in elderly heart failure patients in western Romania
title_sort	factors associated with prolonged hospitalization, readmission, and death in elderly heart failure patients in western romania
publisher	Dove Medical Press
publishDate	2015
url	https://doaj.org/article/85fabce5fcfd4d048e012dc4622df656
work_keys_str_mv	AT gyalaikorposi factorsassociatedwithprolongedhospitalizationreadmissionanddeathinelderlyheartfailurepatientsinwesternromania AT ancusao factorsassociatedwithprolongedhospitalizationreadmissionanddeathinelderlyheartfailurepatientsinwesternromania AT dragomirt factorsassociatedwithprolongedhospitalizationreadmissionanddeathinelderlyheartfailurepatientsinwesternromania AT tomescumc factorsassociatedwithprolongedhospitalizationreadmissionanddeathinelderlyheartfailurepatientsinwesternromania AT marincui factorsassociatedwithprolongedhospitalizationreadmissionanddeathinelderlyheartfailurepatientsinwesternromania
_version_	1718403268588077056

Factors associated with prolonged hospitalization, readmission, and death in elderly heart failure patients in western Romania

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