Identifying patients hospitalized with heart failure at risk for unfavorable future quality of life

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

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Background-Communicating prognosis to enable shared decision-making is strongly endorsed by heart failure (HF) guidelines. Patients are concerned with both their quantity and quality of life (QoL). To facilitate the recognition of patients at high risk for unfavorable future QoL or death, we created a simple prognostic tool to estimate this combined outcome. Methods and Results-We identified factors associated with 6-month mortality or persistently unfavorable QoL, defined by Kansas City Cardiomyopathy Questionnaire (KCCQ) scores <45 at 1 and 24 weeks after hospital discharge, among 1458 patients from the Efficacy of Vasopressin Antagonism in HF Outcome Study with Tolvaptan (EVEREST). Within 24 weeks of discharge, 478 (32.8%) patients had died and 192 (13.2%) patients had serial KCCQ scores <45. After adjusting for 23 predischarge covariates, independent predictors of the combined end point included low admission KCCQ score, high B-type natriuretic peptide, hyponatremia, tachycardia, hypotension, absence of β-blocker therapy, and history of diabetes mellitus and arrhythmia. A simplified predischarge HF score for subsequent death or unfavorable QoL had moderate discrimination (c-statistic 0.72). Predischarge clinical covariates were substantially different in predicting the QoL end point as compared with traditional death or rehospitalization end points. Conclusions-At the time of hospital discharge, readily available clinical characteristics are associated with HF patients at high risk for persistently unfavorable QoL or death over the next 6 months. Such information can target patients for whom aggressive treatment options (eg, devices or transplantation) and/or end-of-life discussions should be strongly considered before hospital discharge.

Original languageEnglish (US)
Pages (from-to)389-398
Number of pages10
JournalCirculation: Cardiovascular Quality and Outcomes
Volume4
Issue number4
DOIs
StatePublished - Jul 1 2011

Fingerprint

Heart Failure
Quality of Life
Cardiomyopathies
Hyponatremia
Brain Natriuretic Peptide
Vasopressins
Tachycardia
Hypotension
Cardiac Arrhythmias
Decision Making
Diabetes Mellitus
Transplantation
Outcome Assessment (Health Care)
Guidelines
Equipment and Supplies
Mortality
Therapeutics
Surveys and Questionnaires

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Identifying patients hospitalized with heart failure at risk for unfavorable future quality of life. / Allen, Larry A.; Gheorghiade, Mihai; Reid, Kimberly J.; Dunlay, Shannon M.; Chan, Paul S.; Hauptman, Paul; Zannad, Faiez; Konstam, Marvin A.; Spertus, John A.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 4, No. 4, 01.07.2011, p. 389-398.

Research output: Contribution to journalArticle

Allen, Larry A. ; Gheorghiade, Mihai ; Reid, Kimberly J. ; Dunlay, Shannon M. ; Chan, Paul S. ; Hauptman, Paul ; Zannad, Faiez ; Konstam, Marvin A. ; Spertus, John A. / Identifying patients hospitalized with heart failure at risk for unfavorable future quality of life. In: Circulation: Cardiovascular Quality and Outcomes. 2011 ; Vol. 4, No. 4. pp. 389-398.
@article{7d3d86f198b34092b5d2904aa39be40d,
title = "Identifying patients hospitalized with heart failure at risk for unfavorable future quality of life",
abstract = "Background-Communicating prognosis to enable shared decision-making is strongly endorsed by heart failure (HF) guidelines. Patients are concerned with both their quantity and quality of life (QoL). To facilitate the recognition of patients at high risk for unfavorable future QoL or death, we created a simple prognostic tool to estimate this combined outcome. Methods and Results-We identified factors associated with 6-month mortality or persistently unfavorable QoL, defined by Kansas City Cardiomyopathy Questionnaire (KCCQ) scores <45 at 1 and 24 weeks after hospital discharge, among 1458 patients from the Efficacy of Vasopressin Antagonism in HF Outcome Study with Tolvaptan (EVEREST). Within 24 weeks of discharge, 478 (32.8{\%}) patients had died and 192 (13.2{\%}) patients had serial KCCQ scores <45. After adjusting for 23 predischarge covariates, independent predictors of the combined end point included low admission KCCQ score, high B-type natriuretic peptide, hyponatremia, tachycardia, hypotension, absence of β-blocker therapy, and history of diabetes mellitus and arrhythmia. A simplified predischarge HF score for subsequent death or unfavorable QoL had moderate discrimination (c-statistic 0.72). Predischarge clinical covariates were substantially different in predicting the QoL end point as compared with traditional death or rehospitalization end points. Conclusions-At the time of hospital discharge, readily available clinical characteristics are associated with HF patients at high risk for persistently unfavorable QoL or death over the next 6 months. Such information can target patients for whom aggressive treatment options (eg, devices or transplantation) and/or end-of-life discussions should be strongly considered before hospital discharge.",
author = "Allen, {Larry A.} and Mihai Gheorghiade and Reid, {Kimberly J.} and Dunlay, {Shannon M.} and Chan, {Paul S.} and Paul Hauptman and Faiez Zannad and Konstam, {Marvin A.} and Spertus, {John A.}",
year = "2011",
month = "7",
day = "1",
doi = "10.1161/CIRCOUTCOMES.110.958009",
language = "English (US)",
volume = "4",
pages = "389--398",
journal = "Circulation: Cardiovascular Quality and Outcomes",
issn = "1941-7713",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Identifying patients hospitalized with heart failure at risk for unfavorable future quality of life

AU - Allen, Larry A.

AU - Gheorghiade, Mihai

AU - Reid, Kimberly J.

AU - Dunlay, Shannon M.

AU - Chan, Paul S.

AU - Hauptman, Paul

AU - Zannad, Faiez

AU - Konstam, Marvin A.

AU - Spertus, John A.

PY - 2011/7/1

Y1 - 2011/7/1

N2 - Background-Communicating prognosis to enable shared decision-making is strongly endorsed by heart failure (HF) guidelines. Patients are concerned with both their quantity and quality of life (QoL). To facilitate the recognition of patients at high risk for unfavorable future QoL or death, we created a simple prognostic tool to estimate this combined outcome. Methods and Results-We identified factors associated with 6-month mortality or persistently unfavorable QoL, defined by Kansas City Cardiomyopathy Questionnaire (KCCQ) scores <45 at 1 and 24 weeks after hospital discharge, among 1458 patients from the Efficacy of Vasopressin Antagonism in HF Outcome Study with Tolvaptan (EVEREST). Within 24 weeks of discharge, 478 (32.8%) patients had died and 192 (13.2%) patients had serial KCCQ scores <45. After adjusting for 23 predischarge covariates, independent predictors of the combined end point included low admission KCCQ score, high B-type natriuretic peptide, hyponatremia, tachycardia, hypotension, absence of β-blocker therapy, and history of diabetes mellitus and arrhythmia. A simplified predischarge HF score for subsequent death or unfavorable QoL had moderate discrimination (c-statistic 0.72). Predischarge clinical covariates were substantially different in predicting the QoL end point as compared with traditional death or rehospitalization end points. Conclusions-At the time of hospital discharge, readily available clinical characteristics are associated with HF patients at high risk for persistently unfavorable QoL or death over the next 6 months. Such information can target patients for whom aggressive treatment options (eg, devices or transplantation) and/or end-of-life discussions should be strongly considered before hospital discharge.

AB - Background-Communicating prognosis to enable shared decision-making is strongly endorsed by heart failure (HF) guidelines. Patients are concerned with both their quantity and quality of life (QoL). To facilitate the recognition of patients at high risk for unfavorable future QoL or death, we created a simple prognostic tool to estimate this combined outcome. Methods and Results-We identified factors associated with 6-month mortality or persistently unfavorable QoL, defined by Kansas City Cardiomyopathy Questionnaire (KCCQ) scores <45 at 1 and 24 weeks after hospital discharge, among 1458 patients from the Efficacy of Vasopressin Antagonism in HF Outcome Study with Tolvaptan (EVEREST). Within 24 weeks of discharge, 478 (32.8%) patients had died and 192 (13.2%) patients had serial KCCQ scores <45. After adjusting for 23 predischarge covariates, independent predictors of the combined end point included low admission KCCQ score, high B-type natriuretic peptide, hyponatremia, tachycardia, hypotension, absence of β-blocker therapy, and history of diabetes mellitus and arrhythmia. A simplified predischarge HF score for subsequent death or unfavorable QoL had moderate discrimination (c-statistic 0.72). Predischarge clinical covariates were substantially different in predicting the QoL end point as compared with traditional death or rehospitalization end points. Conclusions-At the time of hospital discharge, readily available clinical characteristics are associated with HF patients at high risk for persistently unfavorable QoL or death over the next 6 months. Such information can target patients for whom aggressive treatment options (eg, devices or transplantation) and/or end-of-life discussions should be strongly considered before hospital discharge.

UR - http://www.scopus.com/inward/record.url?scp=80053209207&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80053209207&partnerID=8YFLogxK

U2 - 10.1161/CIRCOUTCOMES.110.958009

DO - 10.1161/CIRCOUTCOMES.110.958009

M3 - Article

VL - 4

SP - 389

EP - 398

JO - Circulation: Cardiovascular Quality and Outcomes

JF - Circulation: Cardiovascular Quality and Outcomes

SN - 1941-7713

IS - 4

ER -