Identification of patients at high risk of death is critical for appropriate management
of patients and health care resources. The impact of repeated heart failure (HF) hospitalization
on mortality has not been studied for a large community population with HF. We aimed
to characterize survival of patients in relation to the number of HF hospitalizations.
Using the health care utilization databases, we identified a cohort of patients with
a first hospitalization for HF among all residents of British Columbia between 2000
and 2004. Survival time was measured after patients' first and each subsequent HF
hospitalization. Kaplan-Meier cumulative mortality curves were constructed after each
subsequent HF hospitalization. Hazard ratios for the number of HF hospitalizations
were estimated using a multivariate Cox regression adjusting for major comorbidities.
Of 14,374 patients hospitalized for HF, 7401 died during the 24,766 person-years of
follow-up. Mortality significantly increased after each HF hospitalization. After
adjusting for age, sex, and major comorbidities, the number of HF hospitalizations
was a strong predictor of all-cause death. Median survival after the first, second,
third, and fourth hospitalization was 2.4, 1.4, 1.0, and 0.6 years. Advanced age,
renal disease, and history of cardiac arrest attenuated the impact of the number of
HF hospitalizations.
The number of HF hospitalizations is a strong predictor of mortality in community
HF patients. This simple predictor of mortality in HF patients should help triage
management and resources for HF and trigger patient planning for prognosis.