Causes of death and rehospitalization in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction

Results from efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan (EVEREST) program

Christopher M. O'Connor, Alan B. Miller, John E.A. Blair, Marvin A. Konstam, Patricia Wedge, Maria C. Bahit, Peter Carson, Markus Haass, Paul Hauptman, Marco Metra, Ron M. Oren, Richard Patten, Ileana Piña, Sherryn Roth, Jonathan D. Sackner-Bernstein, Brian Traver, Thomas Cook, Mihai Gheorghiade

Research output: Contribution to journalArticle

150 Citations (Scopus)

Abstract

Background: The postdischarge rehospitalization and death rates are high in patients with acute heart failure (HF) syndromes despite optimization of standard therapy for chronic HF. To the best of our knowledge, there has been no systematic analysis of the causes of death and rehospitalization in this patient population. Methods: This was a prespecified analysis of adjudicated cause-specific all-cause mortality and cardiovascular (CV) hospitalization in the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, a randomized, double-blind, placebo-controlled study in patients hospitalized with worsening HF and left ventricular ejection fraction ≤40% comparing tolvaptan, an oral vasopressin receptor antagonist to placebo, in addition to standard care. Results: Of the 4,133 randomized, there were 5,239 rehospitalizations and 1,080 deaths during a median of 9.9 months. Of all deaths, 41.0% were due to HF, 26.0% due to sudden cardiac death (SCD), 2.6% due to acute myocardial infarction (MI), 2.2% due to stroke, and 13.2% due to non-CV causes. Of all hospitalizations, 39.2% were non-CV, whereas 46.3% were for HF, and a minority of hospitalizations was due to stroke, MI, arrhythmia, or other CV causes. Conclusions: Despite close follow-up and evidence-based therapy within a clinical trial, rehospitalization and death remain high. Although most deaths were from HF, one quarter of patients had SCD. In addition, there were almost as many non-CV hospitalizations as HF hospitalizations. Knowledge of the causes of death and rehospitalization may be essential for proper management and early initiation of therapy.

Original languageEnglish (US)
JournalAmerican Heart Journal
Volume159
Issue number5
DOIs
StatePublished - Jan 1 2010
Externally publishedYes

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Vasopressins
Stroke Volume
Cause of Death
Heart Failure
Outcome Assessment (Health Care)
Hospitalization
Sudden Cardiac Death
Stroke
Myocardial Infarction
Placebos
Mortality
tolvaptan
Secondary Prevention
Cardiac Arrhythmias
Clinical Trials
Therapeutics
Population

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Causes of death and rehospitalization in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction : Results from efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan (EVEREST) program. / O'Connor, Christopher M.; Miller, Alan B.; Blair, John E.A.; Konstam, Marvin A.; Wedge, Patricia; Bahit, Maria C.; Carson, Peter; Haass, Markus; Hauptman, Paul; Metra, Marco; Oren, Ron M.; Patten, Richard; Piña, Ileana; Roth, Sherryn; Sackner-Bernstein, Jonathan D.; Traver, Brian; Cook, Thomas; Gheorghiade, Mihai.

In: American Heart Journal, Vol. 159, No. 5, 01.01.2010.

Research output: Contribution to journalArticle

O'Connor, CM, Miller, AB, Blair, JEA, Konstam, MA, Wedge, P, Bahit, MC, Carson, P, Haass, M, Hauptman, P, Metra, M, Oren, RM, Patten, R, Piña, I, Roth, S, Sackner-Bernstein, JD, Traver, B, Cook, T & Gheorghiade, M 2010, 'Causes of death and rehospitalization in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction: Results from efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan (EVEREST) program', American Heart Journal, vol. 159, no. 5. https://doi.org/10.1016/j.ahj.2010.02.023
O'Connor, Christopher M. ; Miller, Alan B. ; Blair, John E.A. ; Konstam, Marvin A. ; Wedge, Patricia ; Bahit, Maria C. ; Carson, Peter ; Haass, Markus ; Hauptman, Paul ; Metra, Marco ; Oren, Ron M. ; Patten, Richard ; Piña, Ileana ; Roth, Sherryn ; Sackner-Bernstein, Jonathan D. ; Traver, Brian ; Cook, Thomas ; Gheorghiade, Mihai. / Causes of death and rehospitalization in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction : Results from efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan (EVEREST) program. In: American Heart Journal. 2010 ; Vol. 159, No. 5.
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abstract = "Background: The postdischarge rehospitalization and death rates are high in patients with acute heart failure (HF) syndromes despite optimization of standard therapy for chronic HF. To the best of our knowledge, there has been no systematic analysis of the causes of death and rehospitalization in this patient population. Methods: This was a prespecified analysis of adjudicated cause-specific all-cause mortality and cardiovascular (CV) hospitalization in the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, a randomized, double-blind, placebo-controlled study in patients hospitalized with worsening HF and left ventricular ejection fraction ≤40{\%} comparing tolvaptan, an oral vasopressin receptor antagonist to placebo, in addition to standard care. Results: Of the 4,133 randomized, there were 5,239 rehospitalizations and 1,080 deaths during a median of 9.9 months. Of all deaths, 41.0{\%} were due to HF, 26.0{\%} due to sudden cardiac death (SCD), 2.6{\%} due to acute myocardial infarction (MI), 2.2{\%} due to stroke, and 13.2{\%} due to non-CV causes. Of all hospitalizations, 39.2{\%} were non-CV, whereas 46.3{\%} were for HF, and a minority of hospitalizations was due to stroke, MI, arrhythmia, or other CV causes. Conclusions: Despite close follow-up and evidence-based therapy within a clinical trial, rehospitalization and death remain high. Although most deaths were from HF, one quarter of patients had SCD. In addition, there were almost as many non-CV hospitalizations as HF hospitalizations. Knowledge of the causes of death and rehospitalization may be essential for proper management and early initiation of therapy.",
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AU - Miller, Alan B.

AU - Blair, John E.A.

AU - Konstam, Marvin A.

AU - Wedge, Patricia

AU - Bahit, Maria C.

AU - Carson, Peter

AU - Haass, Markus

AU - Hauptman, Paul

AU - Metra, Marco

AU - Oren, Ron M.

AU - Patten, Richard

AU - Piña, Ileana

AU - Roth, Sherryn

AU - Sackner-Bernstein, Jonathan D.

AU - Traver, Brian

AU - Cook, Thomas

AU - Gheorghiade, Mihai

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N2 - Background: The postdischarge rehospitalization and death rates are high in patients with acute heart failure (HF) syndromes despite optimization of standard therapy for chronic HF. To the best of our knowledge, there has been no systematic analysis of the causes of death and rehospitalization in this patient population. Methods: This was a prespecified analysis of adjudicated cause-specific all-cause mortality and cardiovascular (CV) hospitalization in the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, a randomized, double-blind, placebo-controlled study in patients hospitalized with worsening HF and left ventricular ejection fraction ≤40% comparing tolvaptan, an oral vasopressin receptor antagonist to placebo, in addition to standard care. Results: Of the 4,133 randomized, there were 5,239 rehospitalizations and 1,080 deaths during a median of 9.9 months. Of all deaths, 41.0% were due to HF, 26.0% due to sudden cardiac death (SCD), 2.6% due to acute myocardial infarction (MI), 2.2% due to stroke, and 13.2% due to non-CV causes. Of all hospitalizations, 39.2% were non-CV, whereas 46.3% were for HF, and a minority of hospitalizations was due to stroke, MI, arrhythmia, or other CV causes. Conclusions: Despite close follow-up and evidence-based therapy within a clinical trial, rehospitalization and death remain high. Although most deaths were from HF, one quarter of patients had SCD. In addition, there were almost as many non-CV hospitalizations as HF hospitalizations. Knowledge of the causes of death and rehospitalization may be essential for proper management and early initiation of therapy.

AB - Background: The postdischarge rehospitalization and death rates are high in patients with acute heart failure (HF) syndromes despite optimization of standard therapy for chronic HF. To the best of our knowledge, there has been no systematic analysis of the causes of death and rehospitalization in this patient population. Methods: This was a prespecified analysis of adjudicated cause-specific all-cause mortality and cardiovascular (CV) hospitalization in the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, a randomized, double-blind, placebo-controlled study in patients hospitalized with worsening HF and left ventricular ejection fraction ≤40% comparing tolvaptan, an oral vasopressin receptor antagonist to placebo, in addition to standard care. Results: Of the 4,133 randomized, there were 5,239 rehospitalizations and 1,080 deaths during a median of 9.9 months. Of all deaths, 41.0% were due to HF, 26.0% due to sudden cardiac death (SCD), 2.6% due to acute myocardial infarction (MI), 2.2% due to stroke, and 13.2% due to non-CV causes. Of all hospitalizations, 39.2% were non-CV, whereas 46.3% were for HF, and a minority of hospitalizations was due to stroke, MI, arrhythmia, or other CV causes. Conclusions: Despite close follow-up and evidence-based therapy within a clinical trial, rehospitalization and death remain high. Although most deaths were from HF, one quarter of patients had SCD. In addition, there were almost as many non-CV hospitalizations as HF hospitalizations. Knowledge of the causes of death and rehospitalization may be essential for proper management and early initiation of therapy.

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