Re-hospitalizações e morte por insuficiência cardíaca: índices ainda alarmantes / Hospital readmissions and death from heart failure: rates still alarming

FUNDAMENTO: Os pacientes com insuficiência cardíaca (IC) que necessitam ser hospitalizados para compensação constituem grupo de maior gravidade, que evoluem com alta mortalidade e alta taxa de re-hospitalizações. OBJETIVO: Procuramos avaliar a atual história natural da IC por meio da taxa de mortalidade e de re-hospitalizações, nessa nova era do bloqueio neuro-hormonal. MÉTODOS: Acompanhamos a evolução de 263 pacientes com FE média de 27,1 por cento, internados para compensação, entre janeiro de 2005 e outubro de 2006. Foram hospitalizados somente os pacientes que após avaliação e medicação no PS não estavam em condições de ter alta. Os pacientes encontravam-se em CF III/IV, a idade média foi de 59,9±15,2 anos, a maioria homens e 63,1 por cento necessitaram de inotrópicos para compensação na fase aguda. RESULTADOS: O tempo médio de internação foi de 25,1±16,7 dias. Durante a internação 23 (8,8 por cento) morreram. Após a alta, no período médio de seguimento de 370 dias, dos 240 que tiveram alta, 123 (51,2 por cento) procuraram o PS de 1 a 12 vezes (total de passagens: 350), sendo 76 re-internados, sendo a média de dias da re-hospitalização de 23,5±18,0. No primeiro ano de seguimento 62 (25,8 por cento) pacientes morreram. CONCLUSÃO: A IC continua evoluindo com alta mortalidade e alta taxa de re-hospitalização. Ao final do primeiro ano 44,5 por cento desses pacientes não necessitaram passar no PS ou morreram, números que indicam que devemos continuar dando grande atenção aos portadores de IC, na tentativa de mudar a história natural dos portadores dessa síndrome, cada vez mais freqüente.

BACKGROUND: Patients who require hospitalization because of decompensated HF represent a group of the most seriously ill individuals who evolve with high mortality and hospital readmission rates. OBJECTIVES: We sought to evaluate the current natural course of HF by analyzing mortality and readmission rates in this new era of neurohormonal blockage. METHODS: We followed the progress of 263 patients with a mean EF of 27.1 percent, admitted for decompensated HF between January 2005 and October 2006. Patients readmitted were only those whose health status precluded discharge after assessment and drug treatment in the Emergency Department. Patients were classified as HF-FC III/IV, mean age was 59.9±15.2 years, most were men, and 63.1 percent required inotropic drugs for cardiac compensation in the acute phase. RESULTS: Average hospital stay was 25.1±16.7 days. During hospitalization, 23 (8.8 percent) patients died. After discharge, over an average follow-up period of 370 days, of the 240 patients who were discharged 123 (51.2 percent) returned to the Emergency Department 1 to 12 times (total number of visits: 350); 76 of them were readmitted, and the average length of readmission stay was 23.5±18.0 days. Over the first year of follow-up, 62 (25.8 percent) patients died. CONCLUSIONS: HF remains a condition associated with high mortality and high hospital readmission rates. At the end of the first year, 44.5 percent of these patients had not needed to visit the ER or had died, which indicates that we should provide HF patients with the best possible care in an attempt to change the natural course of this increasingly frequent syndrome.

Hospital readmissions and death from Heart Failure--rates still alarming.

BACKGROUND: Patients who require hospitalization because of decompensated HF represent a group of the most seriously ill individuals who evolve with high mortality and hospital readmission rates. OBJECTIVES: We sought to evaluate the current natural course of HF by analyzing mortality and readmission rates in this new era of neurohormonal blockage. METHODS: We followed the progress of 263 patients with a mean EF of 27.1%, admitted for decompensated HF between January 2005 and October 2006. Patients readmitted were only those whose health status precluded discharge after assessment and drug treatment in the Emergency Department. Patients were classified as HF-FC III/IV, mean age was 59.9+/-15.2 years, most were men, and 63.1% required inotropic drugs for cardiac compensation in the acute phase. RESULTS: Average hospital stay was 25.1+/-16.7 days. During hospitalization, 23 (8.8%) patients died. After discharge, over an average follow-up period of 370 days, of the 240 patients who were discharged 123 (51.2%) returned to the Emergency Department 1 to 12 times (total number of visits: 350); 76 of them were readmitted, and the average length of readmission stay was 23.5+/-18.0 days. Over the first year of follow-up, 62 (25.8%) patients died. CONCLUSIONS: HF remains a condition associated with high mortality and high hospital readmission rates. At the end of the first year, 44.5% of these patients had not needed to visit the ER or had died, which indicates that we should provide HF patients with the best possible care in an attempt to change the natural course of this increasingly frequent syndrome.