Among patients with heart failure (HF), hospitalization is a key contributor to morbidity and the overall cost of medical care. Researchers at Brigham and Women’s Hospital reported several years ago in Circulation: Heart Failure that across the spectrum of ejection fractions, patients with HF who were hospitalized for reasons unrelated to cardiovascular (CV) disease had the same risk of mortality as those hospitalized because of a CV cause in general or HF in particular.
Brigham researchers later showed in the Journal of the American College of Cardiology that non-CV hospitalizations are particularly burdensome for patients who have HF with preserved ejection fraction (HFpEF), who tend to have more noncardiac comorbidities than patients who have HF with reduced ejection fraction.
Ebrahim Barkoudah, MD, MPH, medical director at the Brigham and associate director of the Hospital Medicine Unit, and Akshay S. Desai, MD, MPH, medical director of the Center for Advanced Heart Failure/Cardiomyopathy, Advanced Heart Disease Section, and colleagues have now confirmed these findings using data from the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. In patients with HFpEF, hospital admissions for any cause carried a high risk of postdischarge mortality, according to the Journal of Cardiac Failure.
TOPCAT was an international, randomized, double-blind, placebo-controlled trial of how spironolactone affected the incidence of a composite outcome, which included hospitalization for HF, in patients with HFpEF (EF ≥45%). The current analysis focused on the 1,767 participants in the TOPCAT Americas cohort.
During the study, investigators reported all-cause hospitalizations, categorizing them as having a CV cause (HF, myocardial infarction, stroke, or aborted cardiac arrest) or non-CV cause (renal/hyperkalemia, pulmonary, gastrointestinal, or malignancy).
Causes of Hospitalization
During the mean follow-up of 3.3 years, 60% of participants were hospitalized:
- All hospitalizations (n=2,973)—50% had non-CV causes; 28% of all hospitalizations were related to HF
- First hospitalizations (n=1,056)—54% had non-CV causes; 22% of all first hospitalizations were related to HF
Of the 572 first hospitalizations for non-CV causes, the most common reasons were pulmonary (12%) followed by gastrointestinal (8%) and renal (3%).
Death rates were comparable whether the first hospitalization was for:
- CV cause vs. non-CV cause
- HF vs. non-CV cause
Mortality increased with the number of hospitalizations regardless of the cause.
Attention to HFpEF Comorbidities Is Warranted
The need for hospitalization for any reason is a sentinel event in HFpEF, these findings show. Efforts to decrease the overall burden of hospitalization should be an important focus of future efforts to improve care delivery. Meaningful reductions in overall morbidity and mortality may require aggressive therapies that target the management of non-CV comorbidities as well as CV mechanisms.