Predictors of in-hospital mortality in patients hospitalized for heart failure - Insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)

被引:450
作者
Abraham, William T. [1 ]
Fonarow, Gregg C. [2 ]
Albert, Nancy M. [3 ]
Stough, Wendy Gattis [4 ,5 ]
Gheorghiade, Mihai [6 ]
Greenberg, Barry H. [7 ]
O'Connor, Christopher M. [8 ]
Sun, Jie Lena
Yancy, Clyde W. [9 ]
Young, James B. [10 ]
机构
[1] Ohio State Univ, Div Cardiol, Columbus, OH 43210 USA
[2] Univ Calif Los Angeles, Med Ctr, Dept Med, Los Angeles, CA 90024 USA
[3] Cleveland Clin Fdn, George M & Linda H Kaufman Ctr Heart Failure, Cleveland, OH 44195 USA
[4] Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA
[5] Campbell Univ, Sch Pharm, Dept Clin Res, Res Triangle Pk, NC USA
[6] Northwestern Univ, Div Cardiol, Feinberg Sch Med, Chicago, IL 60611 USA
[7] Univ Calif San Diego, Dept Med, UCSD Med Ctr, San Diego, CA 92103 USA
[8] Duke Univ, Med Ctr, Div Cardiol, Duke Clin Res Inst, Durham, NC USA
[9] Baylor Univ, Med Ctr, Dallas, TX USA
[10] Cleveland Clin Fdn, Heart Failure Sect, Dept Cardiovasc Med, Cleveland, OH 44195 USA
关键词
age; heart failure; mortality risk; risk prediction algorithm; serum creatinine; systolic blood pressure;
D O I
10.1016/j.jacc.2008.04.028
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives The aim of this study was to develop a clinical model predictive of in-hospital mortality in a broad hospitalized heart failure ( HF) patient population. Background Heart failure patients experience high rates of hospital stays and poor outcomes. Although predictors of mortality have been identified in HF clinical trials, hospitalized patients might differ greatly from trial populations, and such predictors might underestimate mortality in a real-world population. Methods The OPTIMIZE-HF ( Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) is a registry/performance improvement program for patients hospitalized with HF in 259 U. S. hospitals. Forty-five potential predictor variables were used in a stepwise logistic regression model for in-hospital mortality. Continuous variables that did not meet linearity assumptions were transformed. All significant variables ( p < 0.05) were entered into multivariate analysis. Generalized estimating equations were used to account for the correlation of data within the same hospital in the adjusted models. Results Of 48,612 patients enrolled, mean age was 73.1 years, 52% were women, 74% were Caucasian, and 46% had ischemic etiology. Mean left ventricular ejection fraction was 0.39 +/- 0.18. In-hospital mortality occurred in 1,834 ( 3.8%). Multivariable predictors of mortality included age, heart rate, systolic blood pressure (SBP), sodium, creatinine, HF as primary cause of hospitalization, and presence/absence of left ventricular systolic dysfunction. A scoring system was developed to predict mortality. Conclusions Risk of in-hospital mortality for patients hospitalized with HF remains high and is increased in patients who are older and have low SBP or sodium levels and elevated heart rate or creatinine at admission. Application of this risk- prediction algorithm might help identify patients at high risk for in-hospital mortality who might benefit from aggressive monitoring and intervention.
引用
收藏
页码:347 / 356
页数:10
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