Five Prognostic Factors for Readmission in Patients Over 75 Years Old with Worsening Heart Failure

Abstract

: Heart failure （ HF ） is a common disease in elderly patients, particularly in those presenting as readmission for worsening HF. While recent studies have revealed mortality-associated factors in this population, little is known about prognostic factors associated with worsening HF. To investigate this clinical evidence gap in patients aged over 75 years, we retrospectively investigated 165 patients hospitalized for HF at Showa University Hospital, of whom 65 （ 39.4 ％） were readmitted for worsening HF. We extracted the candidate variables based on univariate analysis, and then elucidated the independent prognostic factors by multivariate analysis. Compared with non-readmitted patients, readmitted patients with worsening HF had lower left ventricular ejection fraction （ LVEF ） （ 39 ％ vs. 50 ％ , P ＝ 0.002 ） and body mass index （ BMI ） （ 19.9 kg/m 2 vs. 21.4 kg/m 2 , P ＝ 0.007 ） , higher levels of B-type natriuretic peptide （ BNP ） （ 478 pg/ml vs. 198 pg/ml, P ＜ 0.001 ） , and heart rate （ HR ） （ 71.0 beats/min vs. 67.0 beats/min, P ＝ 0.021 ） upon discharge during the primary admission. Multivariate logistic analysis identified LVEF ＜ 40 ％ , BMI ＜ 21 kg/m 2 , BNP ≥ 500 pg/ml, Charlson score ≥ 3, and HR ≥ 70 beats/min upon initial discharge as independent prognostic factors. Based on these factors, readmission for worsening HF was more frequent in those with our proposed risk score of ≥ 3.0 than in those with a risk score ＜ 3.0 （ P ＜ 0.001 ） , and we suggested five prognostic factors for HF patients over 75 years old. Our proposed risk score combines these factors and might predict readmission for worsening HF in the elderly population.