Association of persistent and transient worsening renal function with mortality risk, readmissions risk, length of stay, and costs in patients hospitalized with acute heart failure

Abstract

Background

Data comparing effects of transient worsening renal function (WRFt) and persistent WRF (WRFp) on outcomes in patients hospitalized with acute heart failure (AHF) are lacking. We determined the characteristics of hospitalized AHF patients who experienced no worsening renal function (non-WRF), WRFt, or WRFp, and the relationship between cohorts and AHF-related outcomes.

Methods and results

A patient’s first AHF hospitalization (index) was identified in the Cerner Health Facts^® database (January 2008−March 2011). Patients had WRF if serum creatinine (SCr) was ≥0.3 mg/dL and increased ≥25% from baseline, and they were designated as WRFp if present at discharge or WRFt if not present at discharge. A total of 55,436 patients were selected (non-WRF =77%, WRFp =10%, WRFt =13%). WRFp had greater comorbidity burden than WRFt. At index hospitalization, WRFp patients had the highest mortality, whereas WRFt patients had the longest length of stay (LOS) and highest costs. These trends were observed at 30, 180, and 365 days postdischarge and confirmed by multivariable analyses. WRF patients had more AHF-related readmissions than non-WRF patients. In sensitivity analyses of the patient subset with live index hospitalization discharges, postdischarge LOS and costs were highest in WRFt patients, whereas mortality associated with a HF hospitalization was significantly higher for WRF patients vs non-WRF patients, with no difference between WRFp and WRFt.

Conclusion

In patients hospitalized for AHF, WRFp was associated with the highest mortality, whereas WRFt was associated with the highest LOS and costs. WRF patients had higher readmissions than non-WRF patients. Transient increases in SCr appear to be associated with detrimental outcomes, especially longer LOS and higher costs.

Keywords:

• renal function
• acute heart failure
• mortality rate
• health outcomes
• serum creatinine
• cost

Acknowledgments

Medical writing and editorial assistance was provided by Erin P Scott, PhD, of Scott Medical Communications, LLC. This assistance and study were funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. The study sponsor participated in the study design, interpretation of the data, and critical review of the manuscript. The final decision to submit the manuscript was made by the authors.

Disclosure

JBP and KWJ are employees of Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. HSF and PN are paid consultants for Novartis Pharmaceuticals Corporation. SSG received grant support from Novartis and has served as a consultant for Novartis, BMS, and Gambro. The authors report no other conflicts of interest in this work.

Author contributions

JBP, KWJ, and SSG contributed to the study design and interpretation of the data. HSF and PN contributed to data analysis and interpretation of the data. All authors participated in critically reviewing the manuscript for intellectual content, approved the final version for submission, and agreed to be accountable for all aspects of the work.