This interesting article describes a current Archives of Internal Medicine - Reasons Documented for Heart Failure Admissions
At least one identifiable precipitating factor was found in 61.3% of patients, the researchers said. In order of frequency, they were:
Pneumonia or respiratory processes at 15.3%.
Ischemia or acute coronary syndromes at 14.7%.
Arrhythmia at 13.5%.
Uncontrolled hypertension at 10.7%.
Nonadherence to medications at 8.9%.
Worsening renal function at 6.8%.
Nonadherence to diet at 5.2%.
In the cohort as a whole, there were 1,834 deaths in hospital, Dr. Fonarow and colleagues found.
Being admitted with pneumonia increased the risk of dying in hospital by 60% (OR 1.60, 95% CI 1.38 to 1.85, P<0.001).
Worsening renal function was associated with a 48% increase in risk of dying in hospital (OR 1.48, 95% CI 1.23 to 1.79, P<0.001).
And ischemia was linked to a 20% increase in risk of death (OR 1.20, 95% CI 1.03 to 1.40, P=0.02).
On the other hand, being admitted with uncontrolled hypertension was associated with lower in-hospital mortality (OR 0.74, 95% CI 0.55 to 0.94, P=0.04).
I like this information, because it provides an excellent framework for considering CHF exacerbations. I have often had the students and residents think abstractly about the possible causes of CHF exacerbation, but these data provide a hierarchy.
Well done!!
