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QUARTERLY FOCUS ISSUE: HEART FAILURE: CLINICAL RESEARCH

Hospitalizations After Heart Failure Diagnosis

A Community Perspective

Shannon M. Dunlay, MD^_*, Margaret M. Redfield, MD^_*, Susan A. Weston, MS, Terry M. Therneau, PhD, Kirsten Hall Long, PhD, Nilay D. Shah, PhD and Véronique L. Roger, MD, MPH^_*,,_*

^_* Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota

Manuscript received May 6, 2009; revised manuscript received August 25, 2009, accepted August 30, 2009.

^_* Reprint requests and correspondence: Dr. Véronique L. Roger, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 (Email: roger.veronique{at}mayo.edu).

Objectives: The purpose of this study was to determine the lifetime burden and risk factors for hospitalization after heart failure (HF) diagnosis in the community.

Background: Hospitalizations in patients with HF represent a major public health problem; however, the cumulative burden of hospitalizations after HF diagnosis is unknown, and no consistent risk factors for hospitalization have been identified.

Methods: We validated a random sample of all incident HF cases in Olmsted County, Minnesota, from 1987 to 2006 and evaluated all hospitalizations after HF diagnosis through 2007. International Classification of Diseases-9th Revision codes were used to determine the primary reason for hospitalization. To account for repeated events, Andersen-Gill models were used to determine the predictors of hospitalization after HF diagnosis. Patients were censored at death or last follow-up.

Results: Among 1,077 HF patients (mean age 76.8 years, 582 [54.0%] female), 4,359 hospitalizations occurred over a mean follow-up of 4.7 years. Hospitalizations were common after HF diagnosis, with 895 (83.1%) patients hospitalized at least once, and 721 (66.9%), 577 (53.6%), and 459 (42.6%) hospitalized 2, 3, and 4 times, respectively. The reason for hospitalization was HF in 713 (16.5%) hospitalizations and other cardiovascular in 936 (21.6%), whereas over one-half (n = 2,679, 61.9%) were noncardiovascular. Male sex, diabetes mellitus, chronic obstructive pulmonary disease, anemia, and creatinine clearance <30 ml/min were independent predictors of hospitalization (p < 0.05 for each).

Conclusions: Multiple hospitalizations are common after HF diagnosis, though less than one-half are due to cardiovascular causes. Comorbid conditions are strongly associated with hospitalizations, and this information could be used to define effective interventions to prevent hospitalizations in HF patients.

Key Words: heart failure • epidemiology • hospitalization • community • risk factors

Abbreviations and Acronyms   CI = confidence interval   COPD = chronic obstructive pulmonary disease   EF = ejection fraction   HF = heart failure   HR = hazard ratio   ICD-9 = International Classification of Diseases-9th Revision

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