Abstract
Background: The postdischarge rehospitalization and death rates are high in patients with acute heart failure (HF) syndromes despite optimization of standard therapy for chronic HF. To the best of our knowledge, there has been no systematic analysis of the causes of death and rehospitalization in this patient population. Methods: This was a prespecified analysis of adjudicated cause-specific all-cause mortality and cardiovascular (CV) hospitalization in the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, a randomized, double-blind, placebo-controlled study in patients hospitalized with worsening HF and left ventricular ejection fraction ≤40% comparing tolvaptan, an oral vasopressin receptor antagonist to placebo, in addition to standard care. Results: Of the 4,133 randomized, there were 5,239 rehospitalizations and 1,080 deaths during a median of 9.9 months. Of all deaths, 41.0% were due to HF, 26.0% due to sudden cardiac death (SCD), 2.6% due to acute myocardial infarction (MI), 2.2% due to stroke, and 13.2% due to non-CV causes. Of all hospitalizations, 39.2% were non-CV, whereas 46.3% were for HF, and a minority of hospitalizations was due to stroke, MI, arrhythmia, or other CV causes. Conclusions: Despite close follow-up and evidence-based therapy within a clinical trial, rehospitalization and death remain high. Although most deaths were from HF, one quarter of patients had SCD. In addition, there were almost as many non-CV hospitalizations as HF hospitalizations. Knowledge of the causes of death and rehospitalization may be essential for proper management and early initiation of therapy.
| Original language | English (US) |
|---|---|
| Journal | American Heart Journal |
| Volume | 159 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 2010 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Causes of death and rehospitalization in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction : Results from efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan (EVEREST) program. / O'Connor, Christopher M.; Miller, Alan B.; Blair, John E A; Konstam, Marvin A.; Wedge, Patricia; Bahit, Maria C.; Carson, Peter; Haass, Markus; Hauptman, Paul J.; Metra, Marco; Oren, Ron M.; Patten, Richard; Pina, Ileana L.; Roth, Sherryn; Sackner-Bernstein, Jonathan D.; Traver, Brian; Cook, Thomas; Gheorghiade, Mihai.
In: American Heart Journal, Vol. 159, No. 5, 05.2010.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Causes of death and rehospitalization in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction
T2 - Results from efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan (EVEREST) program
AU - O'Connor, Christopher M.
AU - Miller, Alan B.
AU - Blair, John E A
AU - Konstam, Marvin A.
AU - Wedge, Patricia
AU - Bahit, Maria C.
AU - Carson, Peter
AU - Haass, Markus
AU - Hauptman, Paul J.
AU - Metra, Marco
AU - Oren, Ron M.
AU - Patten, Richard
AU - Pina, Ileana L.
AU - Roth, Sherryn
AU - Sackner-Bernstein, Jonathan D.
AU - Traver, Brian
AU - Cook, Thomas
AU - Gheorghiade, Mihai
PY - 2010/5
Y1 - 2010/5
N2 - Background: The postdischarge rehospitalization and death rates are high in patients with acute heart failure (HF) syndromes despite optimization of standard therapy for chronic HF. To the best of our knowledge, there has been no systematic analysis of the causes of death and rehospitalization in this patient population. Methods: This was a prespecified analysis of adjudicated cause-specific all-cause mortality and cardiovascular (CV) hospitalization in the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, a randomized, double-blind, placebo-controlled study in patients hospitalized with worsening HF and left ventricular ejection fraction ≤40% comparing tolvaptan, an oral vasopressin receptor antagonist to placebo, in addition to standard care. Results: Of the 4,133 randomized, there were 5,239 rehospitalizations and 1,080 deaths during a median of 9.9 months. Of all deaths, 41.0% were due to HF, 26.0% due to sudden cardiac death (SCD), 2.6% due to acute myocardial infarction (MI), 2.2% due to stroke, and 13.2% due to non-CV causes. Of all hospitalizations, 39.2% were non-CV, whereas 46.3% were for HF, and a minority of hospitalizations was due to stroke, MI, arrhythmia, or other CV causes. Conclusions: Despite close follow-up and evidence-based therapy within a clinical trial, rehospitalization and death remain high. Although most deaths were from HF, one quarter of patients had SCD. In addition, there were almost as many non-CV hospitalizations as HF hospitalizations. Knowledge of the causes of death and rehospitalization may be essential for proper management and early initiation of therapy.
AB - Background: The postdischarge rehospitalization and death rates are high in patients with acute heart failure (HF) syndromes despite optimization of standard therapy for chronic HF. To the best of our knowledge, there has been no systematic analysis of the causes of death and rehospitalization in this patient population. Methods: This was a prespecified analysis of adjudicated cause-specific all-cause mortality and cardiovascular (CV) hospitalization in the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, a randomized, double-blind, placebo-controlled study in patients hospitalized with worsening HF and left ventricular ejection fraction ≤40% comparing tolvaptan, an oral vasopressin receptor antagonist to placebo, in addition to standard care. Results: Of the 4,133 randomized, there were 5,239 rehospitalizations and 1,080 deaths during a median of 9.9 months. Of all deaths, 41.0% were due to HF, 26.0% due to sudden cardiac death (SCD), 2.6% due to acute myocardial infarction (MI), 2.2% due to stroke, and 13.2% due to non-CV causes. Of all hospitalizations, 39.2% were non-CV, whereas 46.3% were for HF, and a minority of hospitalizations was due to stroke, MI, arrhythmia, or other CV causes. Conclusions: Despite close follow-up and evidence-based therapy within a clinical trial, rehospitalization and death remain high. Although most deaths were from HF, one quarter of patients had SCD. In addition, there were almost as many non-CV hospitalizations as HF hospitalizations. Knowledge of the causes of death and rehospitalization may be essential for proper management and early initiation of therapy.
UR - http://www.scopus.com/inward/record.url?scp=77951653633&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77951653633&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2010.02.023
DO - 10.1016/j.ahj.2010.02.023
M3 - Article
C2 - 20435194
AN - SCOPUS:77951653633
VL - 159
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
IS - 5
ER -