The purpose of this study was to determine the lifetime burden and risk factors for
hospitalization after heart failure (HF) diagnosis in the community.
Hospitalizations in patients with HF represent a major public health problem; however,
the cumulative burden of hospitalizations after HF diagnosis is unknown, and no consistent
risk factors for hospitalization have been identified.
We validated a random sample of all incident HF cases in Olmsted County, Minnesota,
from 1987 to 2006 and evaluated all hospitalizations after HF diagnosis through 2007.
International Classification of Diseases-9th Revision codes were used to determine
the primary reason for hospitalization. To account for repeated events, Andersen-Gill
models were used to determine the predictors of hospitalization after HF diagnosis.
Patients were censored at death or last follow-up.
Among 1,077 HF patients (mean age 76.8 years, 582 [54.0%] female), 4,359 hospitalizations
occurred over a mean follow-up of 4.7 years. Hospitalizations were common after HF
diagnosis, with 895 (83.1%) patients hospitalized at least once, and 721 (66.9%),
577 (53.6%), and 459 (42.6%) hospitalized > or =2, > or =3, and > or =4 times, respectively.
The reason for hospitalization was HF in 713 (16.5%) hospitalizations and other cardiovascular
in 936 (21.6%), whereas over one-half (n = 2,679, 61.9%) were noncardiovascular. Male
sex, diabetes mellitus, chronic obstructive pulmonary disease, anemia, and creatinine
clearance <30 ml/min were independent predictors of hospitalization (p < 0.05 for
Multiple hospitalizations are common after HF diagnosis, though less than one-half
are due to cardiovascular causes. Comorbid conditions are strongly associated with
hospitalizations, and this information could be used to define effective interventions
to prevent hospitalizations in HF patients.