Cluster of 'critical' follow-up evaluations may improve outlook for hospitalized HF patients

March 2, 2010

Heart failure is by far the most prevalent chronic cardiac condition. Around 30 million people in Europe have heart failure and its incidence is still increasing: more cases are being identified, more people are living to an old age, and more are surviving a heart attack but with damage to the heart muscle.

As a result, represents one of the most common reasons for today. However, one of its many challenges is that, following admission, there remains a high likelihood that many patients will be readmitted or die within one year.

Indeed, a new report published in the European Journal of Heart Failure, a journal of the European Society of Cardiology, notes mortality rates as high as 10 per cent and rehospitalisation rates of 30 per cent after discharge among heart failure (HF) patients admitted to hospital. This reflects previous studies of hospitalised Medicare patients in the USA where those with HF had the highest rates of 30-day readmission of any diagnosis.

Now, the authors of the report (from Europe and the USA) have indicated that a range of "critical" follow-up evaluations might efficiently identify these high-risk HF patients so that their treatments and outlook can each be improved. Potential treatments, they suggest, might include "more aggressive" medical or device therapy, increased frequency of follow-up, and enrolment in HF disease management programmes.

This international group of researchers examined 1528 hospitalised HF patients enrolled in the multicentre EVEREST trial. "We analysed our data to help identify which components of a patient's health status, clinical examination or laboratory tests obtained early after were most associated with poor outcomes," said investigator Professor John Spertus from the University of Missouri in Kansas City, USA. "We evaluated which components of the one-week follow-up visit offered the greatest incremental value in predicting cardiovascular rehospitalisation and mortality.

"By clarifying which domains of follow-up evaluation are most important, more efficient strategies for managing discharged HF patients could then be designed. For example, if health status assessments provided the most important information, merely calling patients after discharge might enable accurate risk stratification and guide future treatment decisions. If laboratory tests, such as cardiac biomarkers, conferred the most discrimination, a laboratory visit with review of results by phone might suffice. If is needed to discriminate prognosis, than a clinic visit would be required."

Results of the study showed that the components best able to predict one-year rehospitalisation and mortality were:

  • the HF patient's health status, as determined by a questionnaire
  • physical examination (especially evidence of oedema in the foot
  • laboratory evaluation of biomarkers, the most predictive of which are natriuretic peptides (BNP), anaemia and kidney function (which can all complicate HF)
"While the physical examination, laboratory data, and health questionnaire each provided important individual prognostic information," said Professor Spertus, "the combination of all three provided the greatest accuracy in risk stratification. So it's our belief that a comprehensive assessment one week after hospital discharge, which includes patient history, review of medications, targeted physical examination, laboratory, and health status assessments, may represent the best strategy for identifying HF patients at highest risk for adverse outcomes." Professor Spertus added that the most important elements appeared to be BNP levels, response to a brief health status questionnaire and foot oedema.

Such follow-ups, he explained, provide the opportunity to help physicians best evaluate their HF patients in the hope of reducing mortality and hospitalisation rates in acute HF cases.

Explore further: New method assesses risks for heart failure patients

More information: Dunlay SM, Gheorghiade M, Reid KJ, et al. Critical elements of clinical follow-up after hospital discharge for heart failure: insights from the EVEREST trial. Eur J Heart Fail 2010; doi: 10.1093/eurjhf/hfq019

Related Stories

New method assesses risks for heart failure patients

July 30, 2008

Data from 260 hospitals across the United States has led to the creation of a new method for physicians to more accurately determine the severity of heart failure in patients upon hospital admission, with a goal of reducing ...

Heart failure linked to cognitive impairment

February 5, 2009

Nearly half of patients with heart failure (HF) have problems with memory and other aspects of cognitive functioning, reports a new study published by Elsevier, in the February issue of Journal of Cardiac Failure .

Depression after heart disease ups risk of heart failure

April 13, 2009

Patients with heart disease who are subsequently diagnosed with depression are at greater risk for heart failure (HF), a condition in which the heart can't pump enough blood throughout the body, according to a new study published ...

Novel biomarkers in heart failure

May 30, 2009

Several new biomarkers have been recently described in Heart Failure (HF) syndrome either in stable chronic patients as in the settings of acute decompensation. Biomarkers are used to diagnose disease risk, to predict outcome ...

Heart failure: Women different than men

July 27, 2009

Striking differences in the risk factors for developing heart failure (HF) and patient prognosis exist between men and women. Men and women may also respond differently to treatment, raising concerns about whether current ...

Recommended treatment for heart failure often underused

October 20, 2009

Less than one-third of patients hospitalized for heart failure and participating in a quality improvement registry received a guideline-recommended treatment of heart failure, aldosterone antagonist therapy, according to ...

Recommended for you

How the finch changes its tune

August 3, 2015

Like top musicians, songbirds train from a young age to weed out errors and trim variability from their songs, ultimately becoming consistent and reliable performers. But as with human musicians, even the best are not machines. ...

Machine Translates Thoughts into Speech in Real Time

December 21, 2009

( -- By implanting an electrode into the brain of a person with locked-in syndrome, scientists have demonstrated how to wirelessly transmit neural signals to a speech synthesizer. The "thought-to-speech" process ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.