Right Ventricular Dysfunction As Predictor of Longer Hospital Stay in Patients with Acute Decompensated Heart Failure: a Prospective Study in Indonesian Population

Overview

Journal Cardiovasc Ultrasound

Publisher Biomed Central

Specialties Cardiology & Vascular Diseases
Radiology

Date 2016 Jul 13

PMID 27401733

Citations 5

Authors

Paskariatne Probo Dewi Yamin

Sunu Budhi Raharjo

Vebiona Kartini Prima Putri

Nani Hersunarti

Affiliations

Soon will be listed here.

Abstract

Background: Hospital length of stay (LOS) is a key determinant of heart failure hospitalization costs. Longer LOS is associated with lower quality of care measures and higher rates of readmission and mortality. Right ventricular (RV) dysfunction predicted poor outcomes in patients with stable chronic heart failure (CHF), however, its prognostic value in the acute decompensated heart failure (ADHF) patients has not been sufficiently clarified. This study investigated the prognostic value of RV dysfunction in predicting longer LOS in ADHF patients.

Methods: A prospective cohort study was conducted in National Cardiovascular Center Harapan Kita to all patients admitted with ADHF. Clinical data and baseline RV function assessed by tricuspid annular plane systolic excursion (TAPSE) were collected. Clinical comorbidities including malnutrition, pneumonia and worsening renal function (WRF) were monitored during hospitalization. The primary outcome was hospital LOS. Cox regression analysis was used to identify independent predictors for longer LOS.

Results: Two hundred and fifty-nine ADHF patients were included in this cohort study. On time-to-event analysis, diastolic blood pressure (HR = 1.011; 95 % CI = 1.004-1.018; p = 0.002), hemoglobin levels (HR = 1.102; 95 % CI = 1.045-1.162; p < 0.001), RV function (HR = 0.659; 95 % CI = 0.506-0.857; p = 0.002), WRF (HR = 2.015; 95 % CI = 1.520-2.670; p < 0.001) and malnutrition (HR = 5.965; 95 % CI = 4.402-8.082; p < 0.001) were associated with longer LOS. In a multivariate Cox regression model, RV function (HR = 0.466; 95 % CI = 0.238-0.915; p = 0.026), WRF (HR = 2.985; 95 % CI = 2.032-4.386; p < 0.001) and malnutrition (HR = 7.479; 95 % CI = 5.071-11.030; p < 0.001) were the independent predictors of longer hospital LOS. Based on the median TAPSE values, patients with TAPSE ≤ 16 mm had significantly longer LOS (HR = 2.227; 95 % CI = 1.103-4.494; p = 0.026) compared to those with TAPSE > 16 mm.

Conclusions: Right ventricular dysfunction, WRF and malnutrition are important predictors of longer LOS. This is the first study to describe that in ADHF patients, lower the TAPSE resulted in longer the LOS.

Citing Articles

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Multimodality Imaging of the Right Ventricle.

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References

Harjai K, Nunez E, Turgut T, Shah M, Humphrey J, Newman J . The independent effects of left ventricular ejection fraction on short-term outcomes and resource utilization following hospitalization for heart failure. Clin Cardiol. 1999; 22(3):184-90. PMC: 6655880. DOI: 10.1002/clc.4960220306. View

Wright S, Verouhis D, Gamble G, Swedberg K, Sharpe N, Doughty R . Factors influencing the length of hospital stay of patients with heart failure. Eur J Heart Fail. 2003; 5(2):201-9. DOI: 10.1016/s1388-9842(02)00201-5. View

Forman D, Butler J, Wang Y, Abraham W, OConnor C, Gottlieb S . Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol. 2004; 43(1):61-7. DOI: 10.1016/j.jacc.2003.07.031. View

Kyle U, Pirlich M, Schuetz T, Lochs H, Pichard C . Is nutritional depletion by Nutritional Risk Index associated with increased length of hospital stay? A population-based study. JPEN J Parenter Enteral Nutr. 2004; 28(2):99-104. DOI: 10.1177/014860710402800299. View

Gajanana D, Rammohan H, Alli O, Romero-Corral A, Purushottam B, Ponamgi S . Tricuspid Annular Plane Systolic Excursion and Its Association with Mortality in Critically Ill Patients. Echocardiography. 2015; 32(8):1222-7. DOI: 10.1111/echo.12926. View

Allen L, Smoyer Tomic K, Wilson K, Smith D, Agodoa I . The inpatient experience and predictors of length of stay for patients hospitalized with systolic heart failure: comparison by commercial, Medicaid, and Medicare payer type. J Med Econ. 2012; 16(1):43-54. PMC: 3893694. DOI: 10.3111/13696998.2012.726932. View

Ghio S, RECUSANI F, Klersy C, Sebastiani R, Laudisa M, Campana C . Prognostic usefulness of the tricuspid annular plane systolic excursion in patients with congestive heart failure secondary to idiopathic or ischemic dilated cardiomyopathy. Am J Cardiol. 2000; 85(7):837-42. DOI: 10.1016/s0002-9149(99)00877-2. View

Kyle U, Schneider S, Pirlich M, Lochs H, Hebuterne X, Pichard C . Does nutritional risk, as assessed by Nutritional Risk Index, increase during hospital stay? A multinational population-based study. Clin Nutr. 2005; 24(4):516-24. DOI: 10.1016/j.clnu.2005.04.003. View

Follath F, Yilmaz M, Delgado J, Parissis J, Porcher R, Gayat E . Clinical presentation, management and outcomes in the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF). Intensive Care Med. 2011; 37(4):619-26. DOI: 10.1007/s00134-010-2113-0. View

10.

OMeara E, Chong K, Gardner R, Jardine A, Neilly J, McDonagh T . The Modification of Diet in Renal Disease (MDRD) equations provide valid estimations of glomerular filtration rates in patients with advanced heart failure. Eur J Heart Fail. 2005; 8(1):63-7. DOI: 10.1016/j.ejheart.2005.04.013. View

11.

Meluzin J, Spinarova L, Hude P, Krejci J, Kincl V, Panovsky R . Prognostic importance of various echocardiographic right ventricular functional parameters in patients with symptomatic heart failure. J Am Soc Echocardiogr. 2005; 18(5):435-44. DOI: 10.1016/j.echo.2005.02.004. View

12.

Metra M, Nodari S, Parrinello G, Bordonali T, Bugatti S, Danesi R . Worsening renal function in patients hospitalised for acute heart failure: clinical implications and prognostic significance. Eur J Heart Fail. 2008; 10(2):188-95. DOI: 10.1016/j.ejheart.2008.01.011. View

13.

Brown A, Cleland J . Influence of concomitant disease on patterns of hospitalization in patients with heart failure discharged from Scottish hospitals in 1995. Eur Heart J. 1998; 19(7):1063-9. View

14.

Krantz M, Tanner J, Horwich T, Yancy C, Albert N, Hernandez A . Influence of hospital length of stay for heart failure on quality of care. Am J Cardiol. 2008; 102(12):1693-7. DOI: 10.1016/j.amjcard.2008.08.015. View

15.

Damy T, Kallvikbacka-Bennett A, Goode K, Khaleva O, Lewinter C, Hobkirk J . Prevalence of, associations with, and prognostic value of tricuspid annular plane systolic excursion (TAPSE) among out-patients referred for the evaluation of heart failure. J Card Fail. 2012; 18(3):216-25. DOI: 10.1016/j.cardfail.2011.12.003. View

16.

Hsiao S, Lin S, Wang W, Yang S, Gin P, Liu C . Severe tricuspid regurgitation shows significant impact in the relationship among peak systolic tricuspid annular velocity, tricuspid annular plane systolic excursion, and right ventricular ejection fraction. J Am Soc Echocardiogr. 2006; 19(7):902-10. DOI: 10.1016/j.echo.2006.01.014. View

17.

Verhaert D, Mullens W, Borowski A, Popovic Z, Curtin R, Thomas J . Right ventricular response to intensive medical therapy in advanced decompensated heart failure. Circ Heart Fail. 2010; 3(3):340-6. PMC: 3060051. DOI: 10.1161/CIRCHEARTFAILURE.109.900134. View

18.

Howard L, Grapsa J, Dawson D, Bellamy M, Chambers J, Masani N . Echocardiographic assessment of pulmonary hypertension: standard operating procedure. Eur Respir Rev. 2012; 21(125):239-48. PMC: 9487330. DOI: 10.1183/09059180.00003912. View

19.

Buzby G, Knox L, Crosby L, Eisenberg J, Haakenson C, McNeal G . Study protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients. Am J Clin Nutr. 1988; 47(2 Suppl):366-81. DOI: 10.1093/ajcn/47.2.366. View

20.

Aronson D, Darawsha W, Atamna A, Kaplan M, Makhoul B, Mutlak D . Pulmonary hypertension, right ventricular function, and clinical outcome in acute decompensated heart failure. J Card Fail. 2013; 19(10):665-71. DOI: 10.1016/j.cardfail.2013.08.007. View