PMID- 37007323 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230404 IS - 2168-8184 (Print) IS - 2168-8184 (Electronic) IS - 2168-8184 (Linking) VI - 15 IP - 2 DP - 2023 Feb TI - Real-Life Data on Readmissions of Worsening Heart Failure Outpatients in a Heart Failure Clinic. PG - e35611 LID - 10.7759/cureus.35611 [doi] LID - e35611 AB - Introduction Recurrent hospitalizations for worsening heart failure (WHF) represent a major global public health concern, resulting in significant individual morbimortality and socioeconomic costs. This real-life study aimed to determine the rate and predictors of readmission for WHF in a cohort of outpatients with chronic heart failure (CHF) followed in a heart failure clinic (HFC) at a university hospital. Methods We conducted a longitudinal, observational, and retrospective study of all consecutive CHF patients seen at the HFC of the Sao Francisco Xavier Hospital, Lisbon, by a multidisciplinary team in 2019. The patients were followed for one year and were on optimized therapy. The inclusion criteria for the study were patients who had been hospitalized and subsequently discharged at least three months prior to their enrollment. Patient demographics, heart failure (HF) characterization, comorbidities, pharmacological treatment, treatments of decompensated HF in the day hospital (DH), hospitalizations for WHF, and death were recorded. We applied logistic regression analysis to assess predictors of hospital readmission for HF. Results A total of 351 patients were included: 90 patients (26%) had WHF requiring treatment with intravenous diuretics in the DH; 45 patients (mean age: 79.1 +/- 9.0 years) were readmitted for decompensated HF within one year (12.8%) with no gender difference, while 87.2% of the patients (mean age: 74.9 +/- 12.1 years) were never readmitted. Readmitted patients were significantly older than those who were not (p=0.031). Additionally, they had a higher New York Heart Association (NYHA) functional classification (p<.001), were on a higher daily dose of furosemide (p=0.008) at the time of the inclusion visit, were more frequently affected by the chronic obstructive pulmonary disease (COPD) (p=0.004); had been treated more often in the DH for WHF (p<.001) and had a higher mortality rate (p<.001) at one year. Conclusions This study aimed to determine WHF patient readmission rates and predictors. According to our results, a higher NYHA class, the need for treatment in the DH for WHF, a daily dose of furosemide equal to or greater than 80 mg, and COPD were predictors of readmission for WHF. CHF patients continue to experience WHF and recurrent hospitalizations despite therapeutic advances and close follow-up in the HFC with the multidisciplinary team. Besides COPD, the HF readmission risk factors found were mainly related to advanced disease. Furthermore, the structured and multidisciplinary approach of our disease management program likely contributed to our relatively low rate of readmissions. CI - Copyright (c) 2023, Inacio et al. FAU - Inacio, Hugo AU - Inacio H AD - Internal Medicine, Centro Hospitalar Universitario Lisboa Central - Hospital de Santo Antonio dos Capuchos, Lisbon, PRT. FAU - De Carvalho, Anabela AU - De Carvalho A AD - Internal Medicine, Hospital Senhora da Oliveira, Guimaraes, PRT. FAU - Gamelas De Carvalho, Joana AU - Gamelas De Carvalho J AD - Internal Medicine, Hospital Amato Lusitano, Castelo Branco, PRT. FAU - Maia, Andre AU - Maia A AD - Internal Medicine, Centro Hospitalar de Tras-os-Montes e Alto Douro - Hospital de Vila Real, Vila Real, PRT. FAU - Durao-Carvalho, Goncalo AU - Durao-Carvalho G AD - Internal Medicine, Centro Hospitalar do Oeste - Unidade de Caldas da Rainha, Caldas da Rainha, PRT. FAU - Duarte, Joana AU - Duarte J AD - Intermediate Medical Care Unit, Internal Medicine, Centro Hospitalar de Lisboa Ocidental - Hospital de Sao Francisco Xavier, Lisbon, PRT. FAU - Rodrigues, Catarina AU - Rodrigues C AD - Heart Failure Clinic, Internal Medicine, Centro Hospitalar de Lisboa Ocidental - Hospital de Sao Francisco Xavier, Lisbon, PRT. FAU - Araujo, Ines AU - Araujo I AD - Heart Failure Clinic, Internal Medicine, Centro Hospitalar de Lisboa Ocidental - Hospital de Sao Francisco Xavier, Lisbon, PRT. FAU - Henriques, Celia AU - Henriques C AD - Heart Failure Clinic, Internal Medicine, Centro Hospitalar de Lisboa Ocidental - Hospital de Sao Francisco Xavier, Lisbon, PRT. FAU - Fonseca, Candida AU - Fonseca C AD - Heart Failure Clinic, Internal Medicine, Centro Hospitalar de Lisboa Ocidental - Hospital de Sao Francisco Xavier, Lisbon, PRT. AD - Centro de Estudos de Doencas Cronicas (CEDOC), NOVA Medical School - Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, PRT. LA - eng PT - Journal Article DEP - 20230228 PL - United States TA - Cureus JT - Cureus JID - 101596737 PMC - PMC10063241 OTO - NOTNLM OT - heart failure OT - heart failure management program OT - mortality OT - predictors of readmission OT - readmission OT - worsening heart failure COIS- The authors have declared that no competing interests exist. EDAT- 2023/04/04 06:00 MHDA- 2023/04/04 06:01 PMCR- 2023/02/28 CRDT- 2023/04/03 03:58 PHST- 2023/02/27 00:00 [accepted] PHST- 2023/04/04 06:01 [medline] PHST- 2023/04/03 03:58 [entrez] PHST- 2023/04/04 06:00 [pubmed] PHST- 2023/02/28 00:00 [pmc-release] AID - 10.7759/cureus.35611 [doi] PST - epublish SO - Cureus. 2023 Feb 28;15(2):e35611. doi: 10.7759/cureus.35611. eCollection 2023 Feb.