Abstract 12097: Renal Impairment in Acute Heart Failure: Insights From a Managed Care Database
Background: Multiple epidemiological studies have suggested that comorbid renal impairment is associated with an elevated risk of poor outcomes in heart failure (HF). This study examined short-term morbidity and mortality following hospitalization for acute HF (AHF) in patients with varying chronic kidney disease (CKD) stage.
Methods: A retrospective administrative claims-based study using medical, pharmacy and enrollment data linked to race and laboratory results information from a large US health plan (Jan2007-Sep2012) was conducted. The earliest inpatient stay for HF was defined as index hospitalization. The final sample included adults (≥18 y) with continuous enrollment for: index hospitalization, 12 months pre-index and up to 6 months post-index. Post-index variables were created for the subset of patients with observations post-discharge. Individuals were assigned to CKD stages 1-5 using the CKD-Epidemiology Collaboration Group equation. Chi-square, one-way analysis of variance and log-rank tests were used to examine differences in study variables across CKD stage.
Results: 33,901 AHF patients (mean age 70 y, 51% female, 71% white, 62% Medicare Advantage) were included. Prevalent comorbidities included hypertension (88%) and dyslipidemia (75%).Patients with at least moderately reduced renal function (eGFR ≤60, stages 3-5) when compared to individuals with normal/mild reduction (eGFR ≥60, stages 1-2) experienced higher all-cause readmission (47% vs. 39%), HF-related readmission (31% vs. 21%) and mortality (14% vs. 9%) 6 months post-index hospitalization.
Conclusion: This study provides evidence that risk for readmissions and mortality increases with worsening severity of renal impairment. These results support use of CKD stage as an important risk factor when assessing appropriate management of AHF patients.
- © 2013 by American Heart Association, Inc.