[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.172.195.49. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
1.
Rosamond  WFlegal  KFriday  G  et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee, Heart disease and stroke statistics—2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee [published correction appears in Circulation. 2007; February 6 115(5):e172].  Circulation 2007;115 (5) e69- e171PubMed10.1161/CIRCULATIONAHA.106.179918Google Scholar
2.
Hunt  SAAbraham  WTChin  MH  et al. American College of Cardiology/American Heart Association, ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure).  J Am Coll Cardiol 2001;38 (7) 2101- 2113PubMedGoogle Scholar
3.
Heart Failure Society of America, HFSA 2006 comprehensive heart failure practice guideline.  J Card Fail 2006;12 (1) e1- e122PubMed10.1016/j.cardfail.2005.11.005Google Scholar
4.
Gheorghiade  MZannad  FSopko  G  et al. International Working Group on Acute Heart Failure Syndromes, Acute heart failure syndromes: current state and framework for future research.  Circulation 2005;112 (25) 3958- 3968PubMedGoogle Scholar
5.
Chin  MHGoldman  L Factors contributing to the hospitalization of patients with congestive heart failure.  Am J Public Health 1997;87 (4) 643- 648PubMedGoogle Scholar
6.
Opasich  CFebo  ORiccardi  G  et al.  Concomitant factors of decompensation in chronic heart failure.  Am J Cardiol 1996;78 (3) 354- 357PubMedGoogle Scholar
7.
Michalsen  AKonig  GThimme  W Preventable causative factors leading to hospital admission with decompensated heart failure.  Heart 1998;80 (5) 437- 441PubMedGoogle Scholar
8.
Ghali  JKKadakia  SCooper  RFerlinz  J Precipitating factors leading to decompensation of heart failure: traits among urban blacks.  Arch Intern Med 1988;148 (9) 2013- 2016PubMedGoogle Scholar
9.
Tsuyuki  RT McKelvie  RSAmold  JMO  et al.  Acute precipitants of congestive heart failure exacerbations.  Arch Intern Med 2001;161 (19) 2337- 2342PubMedGoogle Scholar
10.
Fonarow  GCAbraham  WTAlbert  NM  et al.  Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF): rationale and design.  Am Heart J 2004;148 (1) 43- 51PubMedGoogle Scholar
11.
Gheorghiade  MAbraham  WTAlbert  NM  et al. OPTIMIZE-HF Investigators and Coordinators, Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure.  JAMA 2006;296 (18) 2217- 2226PubMedGoogle Scholar
12.
Fonarow  GCAbraham  WTAlbert  NM  et al. OPTIMIZE-HF Investigators and Hospitals, Association between performance measures and clinical outcomes for patients hospitalized with heart failure.  JAMA 2007;297 (1) 61- 70PubMedGoogle Scholar
13.
Fonarow  GCAbraham  WTAlbert  NM  et al. OPTIMIZE-HF Investigators and Hospitals, Influence of a performance-improvement initiative on quality of care for patients hospitalized with heart failure: results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF).  Arch Intern Med 2007;167 (14) 1493- 1502PubMedGoogle Scholar
14.
Joint Commission on Accreditation of Healthcare Organizations, Specification Manual for National Implementation of Hospital Core Measures.  Oakbrook Terrace, IL Joint Commission on Accreditation of Healthcare Organizations2004;
15.
Forman  DEButler  JWang  Y  et al.  Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure.  J Am Coll Cardiol 2004;43 (1) 61- 67PubMedGoogle Scholar
16.
Gottlieb  SSAbraham  WButler  J  et al.  The prognostic importance of different definitions of worsening renal function in congestive heart failure.  J Card Fail 2002;8 (3) 136- 141PubMedGoogle Scholar
17.
Holguin  FFolch  ERedd  SCMannino  DM Comorbidity and mortality in COPD-related hospitalizations in the United States, 1979 to 2001.  Chest 2005;128 (4) 2005- 2011PubMedGoogle Scholar
18.
Granger  BBSwedberg  KEkman  I  et al. CHARM investigators, Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomized, controlled clinical trial.  Lancet 2005;366 (9502) 2005- 2011PubMedGoogle Scholar
19.
Bennett  SJHuster  GABaker  SL  et al.  Characterization of the precipitants of hospitalization for heart failure decompensation.  Am J Crit Care 1998;7 (3) 168- 174PubMedGoogle Scholar
20.
McAlister  FALawson  FMTeo  KKArmstrong  PW A systematic review of randomized trials of disease management programs in heart failure.  Am J Med 2001;110 (5) 378- 384PubMedGoogle Scholar
21.
Haynes  RBTaylor  DWSackett  DLGibson  ESBernholz  CDMukherjee  J Can simple clinical measurements detect patient noncompliance?  Hypertension 1980;2 (6) 757- 764PubMedGoogle Scholar
22.
Curtis  LHHernandez  AFGreiner  MA  et al.  Validity of a national heart failure quality of care registry: comparison of Medicare patients in OPTIMIZE-HF vs. non-OPTIMIZE-HF hospitals [abstract].  Circulation 2007;115 (21) 595Google Scholar
Original Investigation
October 27, 2008

Factors Identified as Precipitating Hospital Admissions for Heart Failure and Clinical Outcomes: Findings From OPTIMIZE-HF

Author Affiliations

Author Affiliations: Department of Medicine, UCLA [University of California, Los Angeles] Medical Center (Dr Fonarow); Division of Cardiology, Ohio State University, Columbus (Dr Abraham); George M. and Linda H. Kaufman Center for Heart Failure (Dr Albert) and Department of Cardiovascular Medicine, Heart Failure Section (Dr Young), Cleveland Clinic Foundation, Cleveland, Ohio; Department of Medicine (Dr Stough) and Division of Cardiology (Dr O’Connor), Duke University Medical Center, Durham, North Carolina; Department of Clinical Research, Campbell University School of Pharmacy, Research Triangle Park, North Carolina (Dr Stough); Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Dr Gheorghiade); Department of Medicine, University of California San Diego Medical Center (Dr Greenberg); Duke Clinical Research Institute, Durham (Dr O’Connor and Mss Pieper and Sun); and Department of Medicine, The University of Texas Southwestern Medical Center, Dallas (Dr Yancy). Dr Yancy is now with Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas.Group Information: A list of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) hospitals and investigators was published in JAMA. 2007;297(1):61-70.

Arch Intern Med. 2008;168(8):847-854. doi:10.1001/archinte.168.8.847
Abstract

Background  Few studies have examined factors identified as contributing to heart failure (HF) hospitalization, and, to our knowledge, none has explored their relationship to length of stay and mortality. This study evaluated the association between precipitating factors identified at the time of HF hospital admission and subsequent clinical outcomes.

Methods  During 2003 to 2004, 259 US hospitals in OPTIMIZE-HF submitted data on 48 612 patients, with a prespecified subgroup of at least 10% providing 60- to 90-day follow-up data. Identifiable factors contributing to HF hospitalization were captured at admission and included ischemia, arrhythmia, nonadherence to diet or medications, pneumonia/respiratory process, hypertension, and worsening renal function. Multivariate analyses were performed for length of stay, in-hospital mortality, 60- to 90-day follow-up mortality, and death/rehospitalization.

Results  Mean patient age was 73.1 years, 52% of patients were female, and mean ejection fraction was 39.0%. Of 48 612 patients, 29 814 (61.3%) had 1 or more precipitating factors identified, with pneumonia/respiratory process (15.3%), ischemia (14.7%), and arrhythmia (13.5%) being most frequent. Pneumonia (odds ratio, 1.60), ischemia (1.20), and worsening renal function (1.48) were independently associated with higher in-hospital mortality, whereas uncontrolled hypertension (0.74) was associated with lower in-hospital mortality. Ischemia (1.52) and worsening renal function (1.46) were associated with a higher risk of follow-up mortality. Uncontrolled hypertension as a precipitating factor was associated with lower postdischarge death/rehospitalization (hazard ratio, 0.71).

Conclusions  Precipitating factors are frequently identified in patients hospitalized for HF and are associated with clinical outcomes independent of other predictive variables. Increased attention to these factors, many of which are avoidable, is important in optimizing the management of HF.

Trial Registration  clinicaltrials.gov Identifier: NCT00344513

×