Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)
Abstract
Background Patients with heart failure (HF) are at high risk for mortality and rehospitalization in the early period after hospital discharge. We developed clinical models predictive of short-term clinical outcomes in a broad patient population discharged after hospitalization for HF.Methods The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry is a comprehensive hospital-based registry and performance-improvement program for patients hospitalized with HF. Follow-up data were scheduled to be prospectively collected at 60 to 90 days postdischarge in a prespecified 10% sample. For the 4,402 patients included in this analysis, 19 prespecified potential predictor variables were used in a stepwise Cox proportional hazards model for all-cause mortality. Logistic regression including 45 potential variables was used to model mortality or rehospitalization.Results The 60- to 90-day postdischarge mortality rate was 8.6% (n = 481), and 29.6% (n = 1,715) were rehospitalized. Factors predicting early postdischarge mortality include age, serum creatinine, reactive airway disease, liver disease, lower systolic blood pressure, lower serum sodium, lower admission weight, and depression. Use of statins and beta-blockers at discharge was associated with significantly decreased mortality. The C-index of the model was 0.74. The most important predictors for the combined end point of death or rehospitalization were admission serum creatinine, systolic blood pressure, admission hemoglobin, discharge use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and pulmonary disease. From this analysis, 8 factors identified to carry significant risk were selected for use in a point scoring system to predict the risk of mortality within 60 days after discharge, with a C-index of 0.72.Conclusions A substantial risk of mortality and mortality or rehospitalization is present in the first 60 to 90 days after discharge from a hospitalization for HF. Several factors were identified that signal high-risk patients. Application of these findings with a simple algorithm can distinguish patients who are low risk from those at high risk who may benefit from closer monitoring and aggressive evidence-based treatment.
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In the OPTIMIZE-HF, ADHERE and Get With the Guidelines-HF registries in the United States, T2DM was not associated with higher in-hospital mortality.
“In the OPTIMIZE-HF, ADHERE and Get With the Guidelines-HF registries in the United States, T2DM was not associated with higher in-hospital mortality.82 -85”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [84]
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- Authors
- O'Connor, C. M., Abraham, W. T., Albert, N. M., Clare, R., Gattis Stough, W., Gheorghiade, M., Greenberg, B. H., Yancy, C. W., Young, J. B., & Fonarow, G. C.
- Affiliations
- The Ohio State University (US)
- Cleveland Clinic (US)
- Duke Clinical Research Institute (US)
- Northwestern University (US)
- University of California San Diego (US)
- Baylor University Medical Center (US)
- University of California, Los Angeles (US)
- ORCID
- Venue
- American Heart Journal
- Publisher
- Elsevier BV
- Published
- 2008-10
- Volume
- 156
- Issue
- 4
- Pages
- 662-673
- ISSN
- 0002-8703 (ISSN-L)
- OpenAlex
- W2119254117
- Cited by
- 430
- References
- 36
- Citations by year
- 2026: 6 · 2025: 17 · 2024: 13 · 2023: 17 · 2022: 11 · 2021: 28 · 2020: 17 · 2019: 26 · 2018: 30 · 2017: 37 · 2016: 31 · 2015: 32 · 2014: 41 · 2013: 29 · 2012: 41
- FWCI
- 12.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Physical Sciences › Engineering › Biomedical Engineering › Mechanical Circulatory Support Devices
- Keywords
- heart failure, post-discharge mortality, hospital readmission, risk prediction, serum creatinine, systolic blood pressure, statins, beta-blockers, ACE inhibitors, angiotensin receptor blockers, depression, risk scoring
- MeSH terms
- Adrenergic beta-Antagonists, Aged, Aged, 80 and over, Hypolipidemic Agents, Blood Pressure, Female, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Patient Readmission, Prognosis, Registries, Proportional Hazards Models, Risk Assessment, Nomograms
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