GSBS Dissertations and Theses

Approval Date

8-18-2014

Document Type

Master's Thesis

Academic Program

Master of Science in Clinical Investigation

Department

Quantitative Health Sciences

First Thesis Advisor

Robert J. Goldberg, PhD

Keywords

Heart Failure, Atrial Fibrillation, Diabetes Mellitus, Hospital Records, Hospitalization, Medical Records, Patient Discharge, Prognosis, Chronic Obstructive Pulmonary Disease, Chronic Renal Insufficiency, Survival Rate

Subjects

Theses, UMMS; Heart Failure; Atrial Fibrillation; Diabetes Mellitus; Hospital Records; Hospitalization; Medical Records; Patient Discharge; Prognosis; Pulmonary Disease, Chronic Obstructive; Renal Insufficiency, Chronic; Survival Rate

Abstract

Limited data exists describing the long-term prognosis of patients with acute decompensated heart failure (ADHF) further stratified according to currently recommended ejection fraction (EF) findings. In addition, little is known about the magnitude of, and factors associated with, long-term prognosis for these patients. Based on previously validated and clinically relevant criteria, we defined HF-REF as patients with an EF value ≤40%, HF-PEF was defined as an EF value > 50%, and HF-BREF was defined as patients with an EF value during their index hospitalization between 41 and 49%. The hospital medical records of residents of the Worcester (MA) metropolitan area who were discharged after ADHF from all 11 medical centers in central Massachusetts during the 5 study years of 1995, 2000, 2002, 2004, and 2006 were reviewed. Follow-up was completed through 2011 for all patient cohorts. The average age of this population was 75 years, the majority was white, and 44% were men. Patients with HF-PEF experienced higher post discharge survival rates than patients with either HF-REF or HF-BREF at 1, 2, and 5-years after discharge. Advanced age and lower estimated glomerular filtration rate findings at the time of hospital admission were important predictors of 1-year death rates, irrespective of EF findings. Previously diagnosed chronic obstructive pulmonary disease, chronic kidney disease, and atrial fibrillation were associated with a poor prognosis in patients with PEF and REF whereas a history of diabetes was an important prognostic factor for patients with REF and BREF. In conclusion, although improvements in 1-year post-discharge survival were observed for patients in each of the 3 EF groups examined to varying degrees, the post- 7 discharge prognosis of all patients with ADHF remains guarded. In addition, we observed differences in several prognostic factors between patients with ADHF with varying EF findings, which have implications for more refined treatment and surveillance plans for these patients.

DOI

10.13028/M2QK5D

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