Association of Cognitive Impairment With Mortality and Readmission in Patients With Heart Failure: A Meta-analysis

Cognitive impairment is a frequent condition in patients with heart failure (HF). This meta-analysis aimed to evaluate the prognostic impact of cognitive impairment on all-cause mortality and readmission among HF patients. We systematically searched articles indexing in PubMed and Embase databases until August 5, 2022. Original studies investigating the association of cognitive impairment with mortality and/or readmission for more than 3-month follow-up in patients with HF were selected. Twelve studies including 9556 patients were eligible. The prevalence of cognitive impairment ranged from 13.5% to 63.4% in HF patients. For patients with cognitive impairment vs those without, the pooled adjusted risk ratio (RR) was 1.88 (95% confidence intervals [CI] 1.42-2.48) for all-cause mortality, 1.48 (95% CI 1.19-1.84) for readmission, and 1.53 (95% CI 1.35-1.73) for combined endpoints of all-cause mortality/readmission, respectively. Cognitive impairment is a significant predictor of all-cause mortality/readmission in patients with HF, even after adjustment for the conventional confounding. Evaluation of cognitive function may help to improve risk classification of HF patients.     

Quadriceps Strength and Mortality in Older Patients With Heart Failure

BackgroundThis study was performed to test the hypothesis that low quadriceps isometric strength (QIS) is associated with greater risk of mortality and has the additive prognostic significance to the severity of heart failure (HF) and gait speed in older patients with HF.MethodsA retrospective cohort study was performed in 1273 patients ≥ 60 years of age with HF (mean age 75 ± 8 years, 59.1% men); all of whom were evaluated during hospitalization for usual gait speed and maximal QIS. The QIS was expressed relative to body mass (% BM). The endpoint was all-cause mortality.ResultsOver a median follow-up period of 1.59 years (interquartile range, 0.58 to 3.42 years), 224 patients died. The cutoff value based on the Youden index for the QIS discriminating those at high risk of mortality was 36.2% BM for overall, and we defined less than this cutoff point of QIS as low QIS. After adjustment for the HF risk score, the hazard ratio in low QIS was 1.55 for overall (95% confidence interval [CI], 1.17-2.06). The addition of low QIS to the HF risk score and gait speed was associated with significant increases in both net reclassification improvement (NRI, 0.239 for overall; 95% CI, 0.096-0.381) and integrated discrimination improvement (IDI, 0.004 for overall; 95% CI, 0.001-0.009) for all-cause mortality.ConclusionLow QIS was strongly associated with poor prognosis and showed complementary prognostic predictive capability to the HF risk score and gait speed in older patients with HF.     

The Association Between Serum Calcium Levels and Short-Term Mortality in Patients with Chronic Heart Failure

Background

Patients with chronic heart failure have vulnerable myocardial function and are susceptible to electrolyte disturbances. In these patients, diuretic treatment is frequently prescribed, though it is known to cause electrolyte disturbances. Therefore, we investigated the association between altered calcium homeostasis and the risk of all-cause mortality in chronic heart failure patients.

Association Between Disease-specific Health-related Quality of Life and All-cause Mortality in Patients with Heart Failure: A Meta-analysis

The association between disease-specific health quality of life (QoL) and adverse outcomes remains controversial in patients with heart failure (HF). This meta-analysis aimed to evaluate the association of QoL measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) or Kansas City Cardiomyopathy Questionnaire (KCCQ) with all-cause mortality in patients with HF. PubMed and Embase databases were comprehensively searched until December 30, 2022 to identify studies investigating the utility of QoL measured by the MLHFQ or KCCQ in predicting all-cause mortality patients with HF. Twenty-five studies reported on 24 articles enrolling 42,414 HF patients were identified. A comparison of the top with the bottom MLHFQ score, the pooled adjusted hazard ratios (HR) of all-cause mortality was 1.56 (95% confidence intervals [CI] 1.26-1.94). When analyzed the MLHFQ as continuous variable, each 10-point MLHFQ score increase conferred a 12% (95% CI 6%-18%) higher risk of all-cause mortality, which was consistently significant for physical component (HR 1.19; 95% CI 1.09-1.30) and mental component (HR 1.21; 95% CI 1.05-1.40). A comparison of the bottom with the top KCCQ score, the pooled adjusted HR was 2.34 (95% CI 2.10–2.60) for all-cause mortality. Furthermore, each 10-point KCCQ score decrease was associated with a 12% (95% CI 7%-16%) higher risk of all-cause mortality. Worse health-related QoL defined by the higher MLHFQ or lower KCCQ score was associated with an increased risk of all-cause mortality in patients with HF. Assessment of disease-specific health QoL at baseline may provide important prognostic information in these patients.     

Sex-Related Differences in Heart Failure and Beta-Blockers

Under-representation of women in heart failure trials has limited our knowledge of heart failure in women to extrapolation of findings from men. Significant sex related differences in clinical and laboratory characteristics exist in systolic heart failure including better survival in women. The value of various therapeutic interventions should be based on proven effect in women and not on an assumption based on proven benefit in men. Among the medications currently recommended for patients with systolic heart failure, beta-blockers have the strongest data supporting their efficacy in women.     

Impact of Comorbidity on Mortality Among Older Persons with Advanced Heart Failure

BACKGROUND  

Care for patients with advanced heart failure (HF) has traditionally focused on managing HF alone; however, little is known about the prevalence and contribution of comorbidity to mortality among this population. We compared the impact of comorbidity on mortality in older adults with HF with high mortality risk and those with lower mortality risk, as defined by presence or absence of a prior hospitalization for HF, respectively.     

Trends in Hospital Readmission of Medicare-Covered Patients With Heart Failure

Background

The Medicare Hospital Readmissions Reduction Program has led to fewer readmissions following hospitalizations with a principal diagnosis of heart failure (HF). Patients with HF are frequently hospitalized for other causes.

Understanding the Relationship Between Readmission and Quality of Hospital Care in Heart Failure

Hospital readmission rates for heart failure (HF) are increasingly seen as a quality metric and are being used to define reimbursement rates and penalize underperforming hospitals. As disease patterns shift from single acute episodes of illness to more chronic and degenerative diseases, healthcare systems across the country are grappling with the challenge of providing quality care while simultaneously controlling both readmission rates and spending. Using HF as a prototypical example of chronic illness, this review begins by describing the historical underpinnings of readmission rates and how they have become a mainstream metric of healthcare quality. It then examines the controversial relationship between hospital quality and readmission rates. The paper examines several strategies to decrease readmission rates, including discharge planning and readmission reduction programs, as well as the relationship between readmission rates and mortality rates. The principal drivers of readmissions are discussed and the impact of new readmission-based financial policy is explored as well.     

The Association Between Socioeconomic Status,Sex, Race / Ethnicity and In-Hospital Mortality Among Patients Hospitalized for Heart Failure

BackgroundThe association between socioeconomic status (SES), sex, race / ethnicity and outcomes during hospitalization for heart failure (HF) has not previously been investigated.Methods and ResultsWe analyzed HF hospitalizations in the United States National Inpatient Sample between 2015 and 2017. Using a hierarchical, multivariable Poisson regression model to adjust for hospital- and patient-level factors, we assessed the association between SES, sex, and race / ethnicity and all-cause in-hospital mortality. We estimated the direct costs (USD) across SES groups. Among 4,287,478 HF hospitalizations, 40.8% were in high SES, 48.7% in female, and 70.0% in White patients. Relative to these comparators, low SES (homelessness or lowest quartile of median neighborhood income) (relative risk [RR] 1.02, 95% confidence interval [CI] 1.00–1.05) and male sex (RR 1.09, 95% CI 1.07–1.11) were associated with increased risk, whereas Black (RR 0.79, 95% CI 0.76–0.81) and Hispanic (RR 0.90, 95% CI 0.86–0.93) race / ethnicity were associated with a decreased risk of in-hospital mortality (5.1% of all hospitalizations). There were significant interactions between race / ethnicity and both, SES (P < .01) and sex (P = .04), such that racial/ethnic differences in outcome were more pronounced in low SES groups and in male patients. The median direct cost of admission was lower in low vs high SES groups ($9324.60 vs $10,940.40), female vs male patients ($9866.60 vs $10,217.10), and Black vs White patients ($9077.20 vs $10,019.80). The median costs increased with SES in all demographic groups primarily related to greater procedural utilization.ConclusionsSES, sex, and race / ethnicity were independently associated with in-hospital mortality during HF hospitalization, highlighting possible care disparities. Racial/ethnic differences in outcome were more pronounced in low SES groups and in male patients.