OBJECTIVE

To determine the annual prognosis and risk factors for re-hospitalization and death after inpatient treatment of acute decompensated chronic heart failure.

MATERIAL AND METHODS

A telephone survey of discharged patients was conducted one year after hospitalization for acute decompensated chronic heart failure. Combined primary endpoint included death or hospitalization for any cause within a year after discharge. Secondary endpoints were death and readmissions within a year. Risk factors for poor prognosis were determined using univariate and multivariate regression analysis. Differences were significant at p-value <0.05.

RESULTS

The annual mortality rate was 41.9% (n=72), incidence of readmissions for any reason — 58.8% (n=101). Combined primary endpoint occurred in 124 (72.1%) patients. According to univariate regression analysis, anemia (OR 1.74, 95% CI 1.09—2.76; p<0.05) upon admission and episode of diuretic resistance (OR 2.37, 95% CI 1.45—3.87; p<0.01). Angiotensin converting enzyme inhibitors/angiotensin II receptor blockers and dapagliflozin were associated with lower 1-year mortality (OR 0.57, 95% CI 0.35 to 0.93; p< 0.05 and OR 0.61, 95% CI 0. 38—0.98; p<0.05, respectively). Anemia (OR 1.92, 95% CI 1.3—2.8; p<0.01), moderate doses of furosemide upon admission (OR 1.01, 95% CI 1.00—1.02; p< 0.05), diuretic resistance (OR 2.44, 95% CI 1.61—3.69; p<0.01) and comorbidity index (OR 1.1, 95% CI 1.01—1.21; p< 0.05) were associated with 1-year readmissions. The incidence of combined primary endpoint was influenced by anemia upon admission (OR 1.56, 95% CI 1.09—2.22; p<0.05) and diuretic resistance (OR 2.05, 95% CI 1.39—3.02; p<0.01). Multivariate regression analysis of all variables significant in univariate analysis revealed only diuretic resistance as a significant predictor of outcomes (death within a year, readmissions and combined primary endpoint) (OR 2.37, 95% 1.45—3. 87; OR 2.44, 95% CI 1.61—3.69, OR 2.13, 95% CI 1.41—3.20, respectively, p<0.01).

CONCLUSION

Resistance to diuretics following treatment of acute decompensated chronic heart failure is an independent predictor of poor prognosis within a year after discharge.