European Journal of Heart Failure Advance Access originally published online on February 21, 2009
European Journal of Heart Failure 2009 11(4):413-419; doi:10.1093/eurjhf/hfp025
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Incidence and predictors of hospitalization or death in patients managed in multidisciplinary heart failure clinics
1 Department of Cardiology B, The Heart Centre, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
2 Department of Cardiology and Endocrinology, Frederiksberg Hospital, Frederiksberg, Denmark
3 Department of Cardiology, Odense University Hospital, Odense, Denmark
4 Department of Internal Medicine, Amager Hospital, Copenhagen, Denmark
5 Department of Internal Medicine, Slagelse Sygehus, Slagelse, Denmark
6 Department of Cardiology and Endocrinology Hillerød Sygehus, Hillerød, Denmark
7 Department of Cardiology, Glostrup Hospital, Glostrup, Denmark
* Corresponding author. Tel: +45 3545 9743, Fax: +45 3545 2513, Email: finng{at}dadlnet.dk
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Abstract |
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Aims: To assess the rates of death or hospitalization in outpatients with heart failure (HF) followed in multidisciplinary, nurse-based HF clinics and to compare the rates with published data from the literature. A second aim was to identify risk factors for death or hospital admission.
Methods and results: A total of 4012 consecutive outpatients referred for HF management in 18 Danish HF clinics were included. Clinical data were collected prospectively. Outcome data were obtained from a validated, national registry. Mean follow-up time was 580 days. The mean age of patients was 69 years, 83% had left ventricular systolic dysfunction and 52% had been hospitalized within 90 days prior to referral to the HF clinic. The 6 and 12 month rates of hospitalization or death were 31 and 42%. Hospitalization or death was significantly predicted by age 1.12 (1.05–1.19), diabetes 1.21 (1.03–1.42), serum creatinine 1.03 (1.02–1.04), NYHA III and IV 1.32 (1.15–1.52), and hospitalization prior to referral to the HF clinic 1.81 (1.57–2.08).
Conclusions: Event rates in this cohort were lower than most published data from HF clinic populations. Factors such as advanced age, NYHA class, and prior hospitalization predict poor outcome in patients managed in multidisciplinary HF clinics.
Key Words: Aged 80 and older • Case management • Beta-blocker • Angiotensin-converting enzyme inhibitor • Mortality • Admission
Received September 10, 2008; Revised December 30, 2008; Accepted January 12, 2009