The Burden of Congestion in Patients Hospitalized With Acute Decompensated Heart Failure

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Congestion is associated with adverse outcomes in heart failure (HF) patients. We characterized congestion in patients hospitalized for HF and examined the association between congestion severity at admission and postdischarge outcomes. Using the OPTIMIZE-HF registry linked to Medicare claims, we analyzed patients ≥65 years old hospitalized for HF from 2003 to 2004. Congestion severity was measured using a 15-point scale that scores dyspnea, orthopnea, fatigue, jugular venous pressure, rales, and edema. Patient characteristics and outcomes were described by congestion strata. Proportional hazards models were fit to examine associations between congestion and 1-year outcomes. Congestion scores for the 24,724 patients ranged from 0 to 14, with a median of 5 (Q1, Q3: 3, 7). At baseline, patients with the highest scores (≥7) had the highest rates of recent HF hospitalizations, EF ≤40%, and co-morbidities, including arrhythmias, diabetes mellitus, and renal insufficiency. Adjusting for patient characteristics, a 3-point congestion score increase was positively associated with mortality (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03, 1.09), all-cause rehospitalization (HR 1.02, 95% CI 1.00, 1.04), and HF rehospitalization (HR 1.09, 95% CI 1.06, 1.12), but not emergency department visits (HR 0.99, 95% CI 0.97, 1.01). In conclusion, for patients hospitalized with HF, congestion was associated with rehospitalization and mortality.

Section snippets

Methods

OPTIMIZE-HF was a multicenter registry of patients hospitalized with ADHF, with a primary or secondary diagnosis of systolic or diastolic HF, in the United States.7 Overall, over 48,000 patients from 259 hospitals were enrolled in the registry between January 2003 and December 2004.8 Each participating center had institutional review board approval for participation in the registry.

Medicare fee-for-service (FFS) standard analytic claims files were obtained from the Centers for Medicare and

Results

There were 29,230 hospitalizations in the OPTIMIZE-HF registry linked to Medicare claims where the patient did not leave against medical advice, 25,844 of which were index hospitalizations (Supplemental Figure 1). There were 24,724 patients with Medicare FFS eligibility during the index hospitalization and through 365 days postdischarge or until death, and these patients were included in the primary study cohort. Analyses of postdischarge outcomes were restricted to the 23,676 patients who were

Discussion

In this analysis from the OPTIMIZE-HF registry, we were able to categorize the severity of congestion for patients with HF at the time of hospital admission and discharge in a real-world clinical practice setting. We found the following: (1) most patients have some degree of congestion on hospital admission, (2) congestion improves during hospitalization, but many patients still have signs and symptoms of congestion at discharge, (3) worse congestion at hospital admission is associated with

Financial Disclosures

Dr. Cooper reported receiving research support from Abbott. Dr. Lippmann reported receiving research support from GlaxoSmithKline during the conduct of the study. Dr. DiBello was an employee and stockholder of GlaxoSmithKline during the conduct of the study. Dr. Gorsh was an employee and stockholder of GlaxoSmithKline during the conduct of the study. Dr. Curtis reports receiving research support from Boston Scientific, Gilead, GlaxoSmithKline, Novartis, and St. Jude Medical. Dr. Sikirica

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    Funding/Support: This project was supported by a research agreement (HO-15-16139) between Glaxo Smith Kline Pharmaceuticals Corporation (Wilmington, DE) and Duke University (Durham, NC).

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