Short and long term survival following hospitalization with a primary versus non-primary diagnosis of acute heart failure.

Abstract

OBJECTIVE: To compare the short-term and long-term outcomes of patients hospitalized with a primary diagnosis of acute heart failure (AHF) versus AHF associated with an alternative principal diagnosis. METHODS: The Israel nationwide Heart Failure (HF) survey examined prospectively 4102 consecutive HF patients admitted to all 25 public hospitals in the country. This study focused on 2302 patients hospitalized with a diagnosis of AHF. In 1594 patients, AHF was the principal diagnosis of hospitalization. In 708 patients, AHF was a secondary diagnosis with an alternative principal diagnosis of hospitalization. RESULTS: Patients with secondary diagnosis of AHF were younger with an overall less comorbidities except for concomitant ischemic heart disease. Despite that, hospital duration was longer (median days (Q1-Q3), 4 (3-7), and 6(4-9), respectively, P<0.001) and in-hospital mortality was higher (7.2% vs. 4.9%, p-value=0.03) among patients with a secondary diagnosis of AHF. Consistently, the age and sex adjusted OR of secondary diagnosis of AHF for in-hospital mortality was 1.76 (C.I. 1.2-2.54; p-val=0.003). However, long-term follow-up showed a risk-reversal wherein the adjusted risk for 10-year mortality was significantly lower among those hospitalized with a secondary vs. primary diagnosis of AHF (HR=0.88, C.I. 0.79-0.99; p-val=0.04). CONCLUSIONS: While hospitalization with secondary diagnosis of AHF is associated with a higher risk for in-hospital mortality in comparison to hospitalization with principal diagnosis of AHF, it is independently associated with a lower risk for 10-year mortality. These findings may have implications for short and long term risk stratification after AHF hospitalization.