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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

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