Risks Remain for Heart Failure Patients Following Hospital Discharge

Muthiah Vaduganathan, MD, MPH

Patients who have been admitted to the hospital for heart failure face a number of risks, including increased rates of death and kidney injuries.

A team, led by Muthiah Vaduganathan, MD, MPH, Brigham and Women ‘s Hospital, accessed outcomes for heart failure patients following hospital discharge including mortality and a number of kidney-related outcomes.

Recent therapies for heart failure have shown the ability to slow the progression of kidney disease. However, the trajectory of clinically relevant kidney events in real-world heart failure care has not been well described.

The Patients

In the study, the investigators identified Medicare beneficiaries hospitalized for heart failure at 240 sites in the US. Each patient was part of the Get With The Guidelines-Heart Failure (GWTG-HF) registry in 2016 and did not require dialysis prior to or during hospitalization.

Each patient was followed for 1 year post-discharge for incident kidney events, all-cause and heart failure readmissions, and death.

The investigators identified associations between discharge Chronic Kidney Disease Epidemiology Collaboration (CDK-EPI-derived) estimated glomerular filtration rate

(eGFR) and time-to-first events, which were adjusted for demographics, medical history, Left ventricular ejection fraction (LVEF), discharge vital sign and laboratory measures, and hospital characteristics.

Overall, there were 20,927 Medicare beneficiaries and the discharge eGFR was ≥90, 60-89, 45-59, 30-44, and <30 mL/min/1.73 m² in 4%, 27%, 23%, 25%, and 21%, respectively.

At the 1 year mark, 37% of the patients had died, while 65% were readmitted to the hospital, including 31% for heart failure, 7% for acute kidney injuries, and 5% for dialysis/end-stage kidney disease (ESKD).

Mortality and Kidney Injuries

The investigators found lower discharge eGFR (per 10 mL/min/1.73 m² decrease) was independently linked to increased mortality (aHR, 1.08; 95% CI, 1.05-1.10), all-cause readmission (aHR, 1.04; 95% CI, [1.02-1.06), heart failure readmission (aHR, 1.09; 95% CI, [1.06-1.12), readmission for AKI (aHR, 1.20; 95% CI, 1.15-1.25), and progression to dialysis/ESKD (aHR, 2.22; 95% CI, 1.93-2.55) (all P<0.001).

After conducting categorical analyses, the investigators consistently found heightened risks of heart failure and kidney events at lower eGFR, with a potential J-shaped relationship observed for mortality and dialysis/ESKD.

“Older adults hospitalized for [heart failure] face broad post-discharge risks of recurrent [heart failure] events, kidney events, and death,” the authors wrote. “One in 20 Medicare beneficiaries are estimated to progress to dialysis/ESKD within 1-year of hospital discharge. These data may inform shared decision-making and highlight the need to prioritize comprehensive HF care that simultaneously improve outcomes in diverse disease pathways.”

The study, “Incident Dialysis and Acute Kidney Injury Among Medicare Beneficiaries After Hospitalization for Heart Failure in the US,” was published online by AHA.