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Letter to editor: Clinical profile and predictors of in-hospital outcome in patients with heart failure
116
Letters to the Editor
Letter to editor: Clinical profile and predictors of in-hospital outcome in patients with heart failure Meltem Refiker Ege a,⁎, Oguzhan Yucel b, Ali Zorlu b, Mehmet Birhan Yilmaz b a b
Kavaklidere Umut Hospital, Cardiology Clinic, Ankara, Turkey Sivas Cumhuriyet University, Department of Cardiology, Sivas, Turkey
a r t i c l e
i n f o
Article history: Received 16 May 2011 Accepted 6 June 2011 Available online 23 June 2011 Keywords: Heart failure Comorbidity Functional status
Dear editor, We have greatly enjoyed reading the recently published manuscript by Biagi et al. [1] related with clinical profile and predictors of in-hospital outcome in patients with heart failure. In this report, functional and cognitive statuses were found to have important influence on patients' outcome. However, systolic blood pressure (SBP) b100 mm Hg, pulse pressure ≥55 mm Hg, and the presence of anemia or permanent bed rest were also found to be significantly related to negative outcomes. It is a fact that heart failure is a universally prevalent, moneyconsuming, and long-standing condition associated with heavy symptom burden, high mortality, and frequent hospital admission [2,3]. Moreover, the mean age of patients with this syndrome is getting older with accompanying comorbidities related with the senility. In this present study [1], the mean age of patients was nearly 79 years and only 10% of patients had isolated heart failure. Although the comorbidities could be the reason for longer hospital stay and also could be the marker of poor outcome and mortality, in this study [1] it was shown that the type rather than the number of comorbidities influenced the outcome. In a recent study [4], consistent with other published reports, increased serum creatinine, older age, increased heart rate, liver disease, cerebrovascular disease, low SBP, and low serum sodium were all found to be associated with in-hospital mortality in patients who were hospitalized for heart failure. In the study of Biagi et al. [1], although glomerular filtration rate and low natremia were not significantly related to worse outcome, anemia and
⁎ Corresponding author at: Kavaklidere Umut Hospital, Buklum Sokak, no 72, Kavaklidere, Ankara, Turkey. Tel.: +90 533 342 41 89; fax: +90 312 466 39 62. E-mail address: [email protected] (M.R. Ege).
0167-5273/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2011.06.035
Barthel Index ≤30 which is a reliable measure of disability were found to be the predictors of poor outcome. Anemia was thought to be the result of associated comorbidities, whereas low Barthel Index could be associated with low systolic blood pressure, brain deficit or permanent bed rest which were also found to be significantly related to negative outcomes. Despite numerous advances in the treatment of chronic heart failure, the high risk of mortality in patients hospitalized for worsening heart failure is still ongoing. In this present study [1], it was reported that drugs whose mortality benefit was established in heart failure were underused at hospital admission. On the other hand, Abraham et al. [4] reported that patients taking an angiotensin-converting enzyme inhibitor or beta-blocker at the time of admission faced lower risk of inhospital mortality. In addition to the comorbidities and the aging heart failure population, the presence of suboptimal medical therapy can also influence the patient's poor outcome. In our opinion, the results of the present study suggest that the inhospital outcome of patients hospitalized for heart failure can be identified with laboratory data, demographic data and vital signs on hospital admission. Identification of high risk patients can alert physicians to target interventions to reduce the short term mortality and also may help them to tailor treatment strategies for improving the long term outcomes. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology. References [1] Biagi P, Gussoni G, Iori I, et al. Clinical profile and predictors of in-hospital outcome in patients with heart failure: the FADOI “CONFINE” study. Int J Cardiol 2011;152:88–94. [2] Jessup M, Brozena S. Heart failure. N Engl J Med 2003;348:2007–18. [3] Tsuchihashi-Makaya M, Hamaguchi S, Kinugawa S, et al. Characteristics and outcomes of hospitalized patients with heart failure and reduced vs preserved ejection fraction. Report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Circ J 2009;73:1893–900. [4] Abraham WT, Fonarow GC, Albert NM, et al. Predictors of in-hospital mortality in patients hospitalized for heart failure: insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). J Am Coll Cardiol 2008;52:347–56.
Letters to the Editor
Letter to editor: Clinical profile and predictors of in-hospital outcome in patients with heart failure Meltem Refiker Ege a,⁎, Oguzhan Yucel b, Ali Zorlu b, Mehmet Birhan Yilmaz b a b
Kavaklidere Umut Hospital, Cardiology Clinic, Ankara, Turkey Sivas Cumhuriyet University, Department of Cardiology, Sivas, Turkey
a r t i c l e
i n f o
Article history: Received 16 May 2011 Accepted 6 June 2011 Available online 23 June 2011 Keywords: Heart failure Comorbidity Functional status
Dear editor, We have greatly enjoyed reading the recently published manuscript by Biagi et al. [1] related with clinical profile and predictors of in-hospital outcome in patients with heart failure. In this report, functional and cognitive statuses were found to have important influence on patients' outcome. However, systolic blood pressure (SBP) b100 mm Hg, pulse pressure ≥55 mm Hg, and the presence of anemia or permanent bed rest were also found to be significantly related to negative outcomes. It is a fact that heart failure is a universally prevalent, moneyconsuming, and long-standing condition associated with heavy symptom burden, high mortality, and frequent hospital admission [2,3]. Moreover, the mean age of patients with this syndrome is getting older with accompanying comorbidities related with the senility. In this present study [1], the mean age of patients was nearly 79 years and only 10% of patients had isolated heart failure. Although the comorbidities could be the reason for longer hospital stay and also could be the marker of poor outcome and mortality, in this study [1] it was shown that the type rather than the number of comorbidities influenced the outcome. In a recent study [4], consistent with other published reports, increased serum creatinine, older age, increased heart rate, liver disease, cerebrovascular disease, low SBP, and low serum sodium were all found to be associated with in-hospital mortality in patients who were hospitalized for heart failure. In the study of Biagi et al. [1], although glomerular filtration rate and low natremia were not significantly related to worse outcome, anemia and
⁎ Corresponding author at: Kavaklidere Umut Hospital, Buklum Sokak, no 72, Kavaklidere, Ankara, Turkey. Tel.: +90 533 342 41 89; fax: +90 312 466 39 62. E-mail address: [email protected] (M.R. Ege).
0167-5273/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2011.06.035
Barthel Index ≤30 which is a reliable measure of disability were found to be the predictors of poor outcome. Anemia was thought to be the result of associated comorbidities, whereas low Barthel Index could be associated with low systolic blood pressure, brain deficit or permanent bed rest which were also found to be significantly related to negative outcomes. Despite numerous advances in the treatment of chronic heart failure, the high risk of mortality in patients hospitalized for worsening heart failure is still ongoing. In this present study [1], it was reported that drugs whose mortality benefit was established in heart failure were underused at hospital admission. On the other hand, Abraham et al. [4] reported that patients taking an angiotensin-converting enzyme inhibitor or beta-blocker at the time of admission faced lower risk of inhospital mortality. In addition to the comorbidities and the aging heart failure population, the presence of suboptimal medical therapy can also influence the patient's poor outcome. In our opinion, the results of the present study suggest that the inhospital outcome of patients hospitalized for heart failure can be identified with laboratory data, demographic data and vital signs on hospital admission. Identification of high risk patients can alert physicians to target interventions to reduce the short term mortality and also may help them to tailor treatment strategies for improving the long term outcomes. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology. References [1] Biagi P, Gussoni G, Iori I, et al. Clinical profile and predictors of in-hospital outcome in patients with heart failure: the FADOI “CONFINE” study. Int J Cardiol 2011;152:88–94. [2] Jessup M, Brozena S. Heart failure. N Engl J Med 2003;348:2007–18. [3] Tsuchihashi-Makaya M, Hamaguchi S, Kinugawa S, et al. Characteristics and outcomes of hospitalized patients with heart failure and reduced vs preserved ejection fraction. Report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Circ J 2009;73:1893–900. [4] Abraham WT, Fonarow GC, Albert NM, et al. Predictors of in-hospital mortality in patients hospitalized for heart failure: insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). J Am Coll Cardiol 2008;52:347–56.