Factors associated with prolonged hospitalization, readmission, and death in elderly heart failure patients in western Romania

PURPOSE: The purpose of this prospective study was to identify factors associated with prolonged hospitalization, readmission, and death in elderly patients presenting heart failure with reduced ejection fraction. PATIENTS AND METHODS: All consecutive patients aged ≥65 years discharged with a diagnosis of acute new-onset heart failure and a left ventricular ejection fraction (LVEF) ≤45% were included and followed up for 1 year. The variables associated with outcomes were analyzed in univariate and multivariate logistic regression. For the independent predictors identified by multivariate analysis, receiver operating characteristic (ROC) analysis was performed. RESULTS: A total of 71 patients were included in the study. The patient mean age was 72.5 years, 50% were female, and the mean LVEF was 31.25%±5.76%. In all, 34 (48%) patients experienced prolonged hospitalization, and this was independently associated with patients who were living in a rural area (P=0.005), those with a New York Heart Association functional class of 4 (P<0.001), the presence of comorbidities (P=0.023), chronic obstructive pulmonary disease (COPD) infectious exacerbation (P<0.001), and chronic kidney disease (P=0.025). In the multivariate analysis, only COPD infectious exacerbation was independently associated with prolonged hospitalization (P=0.003). A total 19 patients (27%) experienced readmissions during the 1-year follow up, of which 12 (17%) had cardiovascular causes and seven (10%) had noncardiovascular causes. The following independent variables associated with rehospitalizations were outlined in the univariate analysis: infections (P<0.020); COPD infectious exacerbation (P=0.015); one or more comorbidity (P<0.0001); and prolonged baseline hospitalization (P<0.0001). During the multivariate analysis, it was found that the independent predictors of readmissions were the presence of comorbidities (P<0.001) and prolonged baseline hospitalization (P<0.01). The 1-year mortality rate was 9.8%, with no significant difference between cardiovascular (5.6%) and noncardiovascular (4.2%) deaths. The only independent predictive variable for mortality was a New York Heart Association NYHA functional class 4 at baseline hospitalization (P=0.001). CONCLUSION: Elderly patients are at high risk for prolonged hospitalization, readmission, and death following a first hospitalization for heart failure with reduced ejection fraction. The most powerful predictors for outcomes are the severity of heart failure, the presence of comorbidities, and prolonged hospitalization at baseline.