Risicofactoren voor een slechte jaarprognose na acute decompensatie van hartfalen

BACKGROUND: Patients with acute decompensation of heart failure (ADHF) have a poor prognosis. According to various sources, hospital mortality is 6-8%, and up to 25% of patients require re-hospitalization within the first 3 months after discharge. Prognosis assessment and identification of high-risk groups have been the focus of HF specialists worldwide in recent years. AIM: To assess the role of clinical, history, laboratory, and instrumental risk factors for the development of adverse events within a year after ADHF. MATERIALS AND METHODS: A retrospective study evaluating medical records (medical charts) included 374 patients aged 18 years or older hospitalized with ADHF. All patients had clinical severity scores greater than 8.5 (NYHA IV) at admission. A comparative analysis of clinical and history data and in-hospital instrumental and laboratory parameters was conducted; outcomes were assessed 1 year after the ADHF episode, namely, repeated hospitalizations for ADHF after discharge and/or death from all causes. RESULTS: During 12 months of follow-up, 81 (27.6%) patients had at least 1 adverse event. Using Cox regression, the four most significant factors for an unfavorable 1-year outcome were determined: anemia (risk ratio - RR 1.57 [95% confidence interval - CI 1.01-2.46]), age over 65 years (RR 1.85 [95% CI 1.18-2.91]), sodium level less than 135 mmol/L at the first measurement (RR 1.86 [95% CI 1.07-3.23]), and male gender (RR 2.0 [95% CI 1.11-3.67]). The C-index of the obtained regression was 0.636 (95% CI 0.575-0.697), and the area under the ROC-curve was 0.658 (95% CI 0.607-0.706). CONCLUSION: According to the study results, age over 65 years, male sex, hyponatremia, and anemia on admission can be regarded as factors of unfavorable 1-year prognosis in patients after an ADHF episode.