Tags

Type your tag names separated by a space and hit enter

Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF).
Am Heart J. 2008 Oct; 156(4):662-73.AH

Abstract

BACKGROUND

Patients with heart failure (HF) are at high risk for mortality and rehospitalization in the early period after hospital discharge. We developed clinical models predictive of short-term clinical outcomes in a broad patient population discharged after hospitalization for HF.

METHODS

The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry is a comprehensive hospital-based registry and performance-improvement program for patients hospitalized with HF. Follow-up data were scheduled to be prospectively collected at 60 to 90 days postdischarge in a prespecified 10% sample. For the 4,402 patients included in this analysis, 19 prespecified potential predictor variables were used in a stepwise Cox proportional hazards model for all-cause mortality. Logistic regression including 45 potential variables was used to model mortality or rehospitalization.

RESULTS

The 60- to 90-day postdischarge mortality rate was 8.6% (n = 481), and 29.6% (n = 1,715) were rehospitalized. Factors predicting early postdischarge mortality include age, serum creatinine, reactive airway disease, liver disease, lower systolic blood pressure, lower serum sodium, lower admission weight, and depression. Use of statins and beta-blockers at discharge was associated with significantly decreased mortality. The C-index of the model was 0.74. The most important predictors for the combined end point of death or rehospitalization were admission serum creatinine, systolic blood pressure, admission hemoglobin, discharge use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and pulmonary disease. From this analysis, 8 factors identified to carry significant risk were selected for use in a point scoring system to predict the risk of mortality within 60 days after discharge, with a C-index of 0.72.

CONCLUSIONS

A substantial risk of mortality and mortality or rehospitalization is present in the first 60 to 90 days after discharge from a hospitalization for HF. Several factors were identified that signal high-risk patients. Application of these findings with a simple algorithm can distinguish patients who are low risk from those at high risk who may benefit from closer monitoring and aggressive evidence-based treatment.

Authors+Show Affiliations

Duke University Medical Center/Duke Clinical Research Institute, Durham, NC 27705, USA. oconn002@mc.duke.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18926148

Citation

O'Connor, Christopher M., et al. "Predictors of Mortality After Discharge in Patients Hospitalized With Heart Failure: an Analysis From the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF)." American Heart Journal, vol. 156, no. 4, 2008, pp. 662-73.
O'Connor CM, Abraham WT, Albert NM, et al. Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Am Heart J. 2008;156(4):662-73.
O'Connor, C. M., Abraham, W. T., Albert, N. M., Clare, R., Gattis Stough, W., Gheorghiade, M., Greenberg, B. H., Yancy, C. W., Young, J. B., & Fonarow, G. C. (2008). Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). American Heart Journal, 156(4), 662-73. https://doi.org/10.1016/j.ahj.2008.04.030
O'Connor CM, et al. Predictors of Mortality After Discharge in Patients Hospitalized With Heart Failure: an Analysis From the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). Am Heart J. 2008;156(4):662-73. PubMed PMID: 18926148.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). AU - O'Connor,Christopher M, AU - Abraham,William T, AU - Albert,Nancy M, AU - Clare,Robert, AU - Gattis Stough,Wendy, AU - Gheorghiade,Mihai, AU - Greenberg,Barry H, AU - Yancy,Clyde W, AU - Young,James B, AU - Fonarow,Gregg C, PY - 2007/11/19/received PY - 2008/04/16/accepted PY - 2008/10/18/pubmed PY - 2008/11/15/medline PY - 2008/10/18/entrez SP - 662 EP - 73 JF - American heart journal JO - Am Heart J VL - 156 IS - 4 N2 - BACKGROUND: Patients with heart failure (HF) are at high risk for mortality and rehospitalization in the early period after hospital discharge. We developed clinical models predictive of short-term clinical outcomes in a broad patient population discharged after hospitalization for HF. METHODS: The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry is a comprehensive hospital-based registry and performance-improvement program for patients hospitalized with HF. Follow-up data were scheduled to be prospectively collected at 60 to 90 days postdischarge in a prespecified 10% sample. For the 4,402 patients included in this analysis, 19 prespecified potential predictor variables were used in a stepwise Cox proportional hazards model for all-cause mortality. Logistic regression including 45 potential variables was used to model mortality or rehospitalization. RESULTS: The 60- to 90-day postdischarge mortality rate was 8.6% (n = 481), and 29.6% (n = 1,715) were rehospitalized. Factors predicting early postdischarge mortality include age, serum creatinine, reactive airway disease, liver disease, lower systolic blood pressure, lower serum sodium, lower admission weight, and depression. Use of statins and beta-blockers at discharge was associated with significantly decreased mortality. The C-index of the model was 0.74. The most important predictors for the combined end point of death or rehospitalization were admission serum creatinine, systolic blood pressure, admission hemoglobin, discharge use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and pulmonary disease. From this analysis, 8 factors identified to carry significant risk were selected for use in a point scoring system to predict the risk of mortality within 60 days after discharge, with a C-index of 0.72. CONCLUSIONS: A substantial risk of mortality and mortality or rehospitalization is present in the first 60 to 90 days after discharge from a hospitalization for HF. Several factors were identified that signal high-risk patients. Application of these findings with a simple algorithm can distinguish patients who are low risk from those at high risk who may benefit from closer monitoring and aggressive evidence-based treatment. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/18926148/Predictors_of_mortality_after_discharge_in_patients_hospitalized_with_heart_failure:_an_analysis_from_the_Organized_Program_to_Initiate_Lifesaving_Treatment_in_Hospitalized_Patients_with_Heart_Failure__OPTIMIZE_HF__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(08)00323-2 DB - PRIME DP - Unbound Medicine ER -