Critical elements of clinical follow-up after hospital discharge for heart failure

Insights from the EVEREST trial

Shannon M. Dunlay, Mihai Gheorghiade, Kimberly J. Reid, Larry A. Allen, Paul S. Chan, Paul Hauptman, Faiez Zannad, Aldo P. Maggioni, Karl Swedberg, Marvin A. Konstam, John A. Spertus

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Aims Hospitalized heart failure (HF) patients are at high risk for death and readmission. We examined the incremental value of data obtained 1 week after HF hospital discharge in predicting mortality and readmission.Methods and resultsIn the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with tolvaptan, 1528 hospitalized patients (ejection fraction ≤40) with a physical examination, laboratories, and health status [Kansas City Cardiomyopathy Questionnaire (KCCQ)] assessments 1 week after discharge were included. The ability to predict 1 year cardiovascular rehospitalization and mortality was assessed with Cox models, c-statistics, and the integrated discrimination improvement (IDI). Not using a beta-blocker, rales, pedal oedema, hyponatraemia, lower creatinine clearance, higher brain natriuretic peptide, and worse health status were independent risk factors for rehospitalization and death. The c-statistic for the base model (history and medications) was 0.657. The model improved with physical examination, laboratory, and KCCQ results, with IDI increases of 4.9, 7.0, and 3.2, respectively (P < 0.001 each). The combination of all three offered the greatest incremental gain (c-statistic 0.749; IDI increase 10.8).ConclusionPhysical examination, laboratories, and KCCQ assessed 1 week after discharge offer important prognostic information, suggesting that all are critical components of outpatient evaluation after HF hospitalization.

Original languageEnglish (US)
Pages (from-to)367-374
Number of pages8
JournalEuropean Journal of Heart Failure
Volume12
Issue number4
DOIs
StatePublished - Apr 1 2010

Fingerprint

Heart Failure
Cardiomyopathies
Health Status
Physical Examination
Mortality
Hyponatremia
Brain Natriuretic Peptide
Respiratory Sounds
Vasopressins
Proportional Hazards Models
Foot
Edema
Creatinine
Hospitalization
Outpatients
History
Outcome Assessment (Health Care)
Surveys and Questionnaires

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Critical elements of clinical follow-up after hospital discharge for heart failure : Insights from the EVEREST trial. / Dunlay, Shannon M.; Gheorghiade, Mihai; Reid, Kimberly J.; Allen, Larry A.; Chan, Paul S.; Hauptman, Paul; Zannad, Faiez; Maggioni, Aldo P.; Swedberg, Karl; Konstam, Marvin A.; Spertus, John A.

In: European Journal of Heart Failure, Vol. 12, No. 4, 01.04.2010, p. 367-374.

Research output: Contribution to journalArticle

Dunlay, SM, Gheorghiade, M, Reid, KJ, Allen, LA, Chan, PS, Hauptman, P, Zannad, F, Maggioni, AP, Swedberg, K, Konstam, MA & Spertus, JA 2010, 'Critical elements of clinical follow-up after hospital discharge for heart failure: Insights from the EVEREST trial', European Journal of Heart Failure, vol. 12, no. 4, pp. 367-374. https://doi.org/10.1093/eurjhf/hfq019
Dunlay, Shannon M. ; Gheorghiade, Mihai ; Reid, Kimberly J. ; Allen, Larry A. ; Chan, Paul S. ; Hauptman, Paul ; Zannad, Faiez ; Maggioni, Aldo P. ; Swedberg, Karl ; Konstam, Marvin A. ; Spertus, John A. / Critical elements of clinical follow-up after hospital discharge for heart failure : Insights from the EVEREST trial. In: European Journal of Heart Failure. 2010 ; Vol. 12, No. 4. pp. 367-374.
@article{fa92ec75ccdc43e48aedf240a0994feb,
title = "Critical elements of clinical follow-up after hospital discharge for heart failure: Insights from the EVEREST trial",
abstract = "Aims Hospitalized heart failure (HF) patients are at high risk for death and readmission. We examined the incremental value of data obtained 1 week after HF hospital discharge in predicting mortality and readmission.Methods and resultsIn the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with tolvaptan, 1528 hospitalized patients (ejection fraction ≤40) with a physical examination, laboratories, and health status [Kansas City Cardiomyopathy Questionnaire (KCCQ)] assessments 1 week after discharge were included. The ability to predict 1 year cardiovascular rehospitalization and mortality was assessed with Cox models, c-statistics, and the integrated discrimination improvement (IDI). Not using a beta-blocker, rales, pedal oedema, hyponatraemia, lower creatinine clearance, higher brain natriuretic peptide, and worse health status were independent risk factors for rehospitalization and death. The c-statistic for the base model (history and medications) was 0.657. The model improved with physical examination, laboratory, and KCCQ results, with IDI increases of 4.9, 7.0, and 3.2, respectively (P < 0.001 each). The combination of all three offered the greatest incremental gain (c-statistic 0.749; IDI increase 10.8).ConclusionPhysical examination, laboratories, and KCCQ assessed 1 week after discharge offer important prognostic information, suggesting that all are critical components of outpatient evaluation after HF hospitalization.",
author = "Dunlay, {Shannon M.} and Mihai Gheorghiade and Reid, {Kimberly J.} and Allen, {Larry A.} and Chan, {Paul S.} and Paul Hauptman and Faiez Zannad and Maggioni, {Aldo P.} and Karl Swedberg and Konstam, {Marvin A.} and Spertus, {John A.}",
year = "2010",
month = "4",
day = "1",
doi = "10.1093/eurjhf/hfq019",
language = "English (US)",
volume = "12",
pages = "367--374",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "Oxford University Press",
number = "4",

}

TY - JOUR

T1 - Critical elements of clinical follow-up after hospital discharge for heart failure

T2 - Insights from the EVEREST trial

AU - Dunlay, Shannon M.

AU - Gheorghiade, Mihai

AU - Reid, Kimberly J.

AU - Allen, Larry A.

AU - Chan, Paul S.

AU - Hauptman, Paul

AU - Zannad, Faiez

AU - Maggioni, Aldo P.

AU - Swedberg, Karl

AU - Konstam, Marvin A.

AU - Spertus, John A.

PY - 2010/4/1

Y1 - 2010/4/1

N2 - Aims Hospitalized heart failure (HF) patients are at high risk for death and readmission. We examined the incremental value of data obtained 1 week after HF hospital discharge in predicting mortality and readmission.Methods and resultsIn the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with tolvaptan, 1528 hospitalized patients (ejection fraction ≤40) with a physical examination, laboratories, and health status [Kansas City Cardiomyopathy Questionnaire (KCCQ)] assessments 1 week after discharge were included. The ability to predict 1 year cardiovascular rehospitalization and mortality was assessed with Cox models, c-statistics, and the integrated discrimination improvement (IDI). Not using a beta-blocker, rales, pedal oedema, hyponatraemia, lower creatinine clearance, higher brain natriuretic peptide, and worse health status were independent risk factors for rehospitalization and death. The c-statistic for the base model (history and medications) was 0.657. The model improved with physical examination, laboratory, and KCCQ results, with IDI increases of 4.9, 7.0, and 3.2, respectively (P < 0.001 each). The combination of all three offered the greatest incremental gain (c-statistic 0.749; IDI increase 10.8).ConclusionPhysical examination, laboratories, and KCCQ assessed 1 week after discharge offer important prognostic information, suggesting that all are critical components of outpatient evaluation after HF hospitalization.

AB - Aims Hospitalized heart failure (HF) patients are at high risk for death and readmission. We examined the incremental value of data obtained 1 week after HF hospital discharge in predicting mortality and readmission.Methods and resultsIn the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with tolvaptan, 1528 hospitalized patients (ejection fraction ≤40) with a physical examination, laboratories, and health status [Kansas City Cardiomyopathy Questionnaire (KCCQ)] assessments 1 week after discharge were included. The ability to predict 1 year cardiovascular rehospitalization and mortality was assessed with Cox models, c-statistics, and the integrated discrimination improvement (IDI). Not using a beta-blocker, rales, pedal oedema, hyponatraemia, lower creatinine clearance, higher brain natriuretic peptide, and worse health status were independent risk factors for rehospitalization and death. The c-statistic for the base model (history and medications) was 0.657. The model improved with physical examination, laboratory, and KCCQ results, with IDI increases of 4.9, 7.0, and 3.2, respectively (P < 0.001 each). The combination of all three offered the greatest incremental gain (c-statistic 0.749; IDI increase 10.8).ConclusionPhysical examination, laboratories, and KCCQ assessed 1 week after discharge offer important prognostic information, suggesting that all are critical components of outpatient evaluation after HF hospitalization.

UR - http://www.scopus.com/inward/record.url?scp=77950295232&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77950295232&partnerID=8YFLogxK

U2 - 10.1093/eurjhf/hfq019

DO - 10.1093/eurjhf/hfq019

M3 - Article

VL - 12

SP - 367

EP - 374

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

IS - 4

ER -