Readmission following both cardiac and non-cardiac acute dyspnoea is associated with a striking risk of death

Kamilė Čerlinskaitė; Alexandre Mebazaa; Raphaël Cinotti; Michael Matthay; Desiree N Wussler; Etienne Gayat; Vytautas Juknevičius; Nikola Kozhuharov; Julia Dinort; Eleni Michou; Danielle M Gualandro; Eglė Palevičiūtė; Irina Alitoit-Marrote; Denis Kablučko; Loreta Bagdonaitė; Mindaugas Balčiūnas; Dovilė Vaičiulienė; Ieva Jonauskienė; Justina Motiejūnaitė; Kęstutis Stašaitis; Audrys Kukulskis; Šarūnas Damalakas; Aleksandras Laucevičius; Christian Mueller; Aušra Kavoliūnienė; Jelena Čelutkienė; GREAT network

doi:10.1002/ehf2.13369

Readmission following both cardiac and non-cardiac acute dyspnoea is associated with a striking risk of death

ESC Heart Fail. 2021 Aug;8(4):2473-2484. doi: 10.1002/ehf2.13369. Epub 2021 Jun 10.

Authors

Kamilė Čerlinskaitė^{1

2

3}, Alexandre Mebazaa^{2

3

4}, Raphaël Cinotti⁵, Michael Matthay^{6

7}, Desiree N Wussler⁸, Etienne Gayat^{2

3

4}, Vytautas Juknevičius^{1

9}, Nikola Kozhuharov⁸, Julia Dinort⁸, Eleni Michou⁸, Danielle M Gualandro⁸, Eglė Palevičiūtė^{1

9}, Irina Alitoit-Marrote⁹, Denis Kablučko⁹, Loreta Bagdonaitė^{10

11}, Mindaugas Balčiūnas^{1

9}, Dovilė Vaičiulienė¹², Ieva Jonauskienė¹², Justina Motiejūnaitė¹², Kęstutis Stašaitis¹², Audrys Kukulskis¹², Šarūnas Damalakas¹², Aleksandras Laucevičius¹, Christian Mueller⁸, Aušra Kavoliūnienė¹², Jelena Čelutkienė^{1

9}; GREAT network

Affiliations

¹ Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
² Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Paris, France.
³ Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique des Hopitaux de Paris, 2 Rue Ambroise Paré, Paris, 75010, France.
⁴ Université de Paris, Paris, France.
⁵ Department of Anesthesia and Critical Care, Hôpital Laennec, University Hospital of Nantes, Saint-Herblain, France.
⁶ Department of Medicine and Anesthesia, University of California, San Francisco, CA, USA.
⁷ Cardiovascular Research Institute, University of California, San Francisco, CA, USA.
⁸ Cardiology Department and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
⁹ Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
¹⁰ Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
¹¹ Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
¹² Lithuanian University of Health Sciences, Kaunas, Lithuania.

Abstract

Aims: Readmission and mortality are the most common and often combined endpoints in acute heart failure (AHF) trials, but an association between these two outcomes is poorly investigated. The aim of this study was to determine whether unplanned readmission is associated with a greater subsequent risk of death in patients with acute dyspnoea due to cardiac and non-cardiac causes.

Methods and results: Derivation cohort (1371 patients from the LEDA study) and validation cohort (1986 patients from the BASEL V study) included acute dyspnoea patients admitted to the emergency department. Cox regression analysis was used to determine the association of 6 month readmission and the risk of 1 year all-cause mortality in AHF and non-AHF patients and those readmitted due to cardiovascular and non-cardiovascular causes. In the derivation cohort, 666 (49%) of patients were readmitted at 6 months and 282 (21%) died within 1 year. Six month readmission was associated with an increased 1 year mortality risk in both the derivation cohort [adjusted hazard ratio (aHR) 3.0 (95% confidence interval, CI 2.2-4.0), P < 0.001] and the validation cohort (aHR 1.8, 95% CI 1.4-2.2, P < 0.001). The significant association was similarly observed in AHF (aHR 3.2, 95% CI 2.1-4.9, P < 0.001) and other causes of acute dyspnoea (aHR 2.9, 95% CI 1.9-4.5, P < 0.001), and it did not depend on the aetiology [aHR 2.2, 95% CI 1.6-3.1 for cardiovascular readmissions; aHR 4.1, 95% CI 2.9-5.7 for non-cardiovascular readmissions (P < 0.001 for both)] or timing of readmission. CONCLUSIONS: Our study demonstrated a long-lasting detrimental association between readmission and death in AHF and non-AHF patients with acute dyspnoea. These patients should be considered 'vulnerable patients' that require personalized follow-up for an extended period.

Keywords: Acute dyspnoea; Acute heart failure; Emergency department; Mortality; Readmission; Vulnerable phase.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Dyspnea / epidemiology
Dyspnea / etiology
Heart Failure* / complications
Hospitalization
Humans
Patient Readmission*