Abstract 3169: Increase in Risk of Death in Early Months Following Hospitalization for Heart Failure: Observations from the CHARM Program
Background: Patients with chronic heart failure (HF) are at increased risk for both fatal and non-fatal major adverse cardiovascular events. We assessed the influence of non-fatal hospitalization for heart failure on subsequent mortality in a broad spectrum of heart failure patients enrolled in the CHARM program.
Methods: Patients with NYHA class II to IV heart failure were randomized to placebo or candesartan. We assessed the risk of mortality following a discharge from a first hospitalization for heart failure using time-updated Cox proportional hazards models on 7572 patients.
Results: 1455 (19%) patients had at least one adjudicated hospitalization for heart failure, and 586/1819 (32%) of all deaths occurred after a discharge following a HF hospitalization. Risk of death was increased following a discharge from a HF hospitalization, even after adjusting for baseline predictors of mortality (HR 2.9, 95% CI, 2.6, 3.3). The hazard ratio for death was 5.8 in the first month after hospitalization, compared with 2.1 after a year. Hospital stay over three weeks was associated with twice the risk of a hospitalization of < 1 week. Both time from and duration of hospitalization were predictive of mortality independently of each other (Figure⇓). The impact of a hospitalization for HF was most marked for death due to heart failure and sudden death.
Conclusions: In patients with chronic HF in CHARM, the risk of death was greatest in the early period following discharge after a hospitalization for heart failure and was directly related to the duration of hospitalization. Optimal monitoring and management during this vulnerable period may provide an opportunity to improve outcome.