Causes and predictors of hospital readmissions in patients older than 65 years hospitalized for heart failure with preserved left ventricular ejection fraction in western Romania

Figures & data

Table 1 Differences between HFpEF patients according to age, at baseline

Characteristics	Age ≥65 years (n=98)	Age <65 years (n=80)	P-value
Women	58 (59)	22 (28)	0.0001*
Lonely	45 (46)	30 (38)	0.3566
Primary etiology of HF
Ischemic	20 (22)	27 (34)	0.1059
Non-ischemic	76 (78)	53 (66)	0.1059
NYHA class
III	20 (21)	47 (46)	0.0007*
IV	78 (79)	33 (54)	0.0007*
Hypertension	86 (88)	50 (63)	<0.0001*
CAD	54 (55)	54 (80)	0.0005*
Old MI	23 (24)	16 (20)	0.6473
Atrial fibrillation	50 (52)	20 (26)	0.0001*
Heart rate at admission (bpm)	75±16	83±17	0.0015*
DM	33 (34)	24 (30)	0.2498
Metabolic syndrome	70 (72)	32 (40)	<0.0001*
Obesity	60 (61)	25 (32)	0.0002*
CKD	62 (63)	25 (31)	<0.0001*
COPD	27 (28)	17 (21)	0.3678
Peripheral artery disease	17 (16)	9 (12)	0.5860
Anemia	19 (20)	11 (14)	0.3934
Degenerative osteoarthritis	34 (35)	22 (28)	0.4035
History of stroke	7 (7)	4 (5)	0.8105
History of cancer	3 (3)	1 (1)	0.689
ACE-I	48 (49)	49 (62)	0.1136
ARBs	34 (35)	17 (21)	0.0591
Beta blockers	86 (88)	66 (83)	0.4631
Ivabradine	37 (38)	33 (42)	0.6977
Furosemide	84 (86)	45 (57)	<0.0001*
Spironolactone	84 (86)	45 (57)	<0.0001*
Statins	52 (53)	62 (78)	0.0010*
BNP (pg/mL)	428 (312–522)	390 (301–547)	0.6672
NT-proBNP (pg/mL)	730 (376–973)	485 (322–885)	0.2324
TNF-α (pg/mL)	10.3 (9.0–13.0)	7.2 (5.8–12.0)	<0.0001*
IL-6 (pg/mL)	4.5 (1.8–5.4)	2.2 (1.5–3.0)	0.0001*
hs-CRP (mg/L)	5.8 (3.2–18.5)	2.5 (1.2–2.9)	<0.0001*
MLHFQ score	48 (44–53)	42 (33–64)	0.0052*
6MWT (m)	255 (165–282)	259 (220–319)	0.0293*
Fahrenberg scale score	8.0 (7.0–10.0)	7.0 (6.0–9.0)	0.0024*

Notes: Categorical variables are presented as number (%). Continuous data are presented as mean ±1 standard deviation when normally distributed and as median (interquartile range) when skewed.

* P-value <0.05.

Abbreviations: HFpEF, heart failure with preserved ejection fraction; HF, heart failure; NYHA, New York Heart Association; CAD, coronary artery disease; bpm, beats per minute; MI, myocardial infarction; DM, diabetes mellitus; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; ACE-I, angiotensin-converting enzyme inhibitors; ARBs, angiotensin receptor blockers; BNP, brain natriuretic peptide; NT-proBNP, N-terminal-pro-brain natriuretic peptide; TNF, tumor necrosis factor; IL, interleukin; hs-CRP, high-sensitivity C-reactive protein; MLHFQ, Minnesota living with heart failure questionnaire; 6MWT, 6-minute walk test.

Table 2 Differences between HFpEF patients according to age, at 1-year follow-up

Characteristics	Age ≥65 years (n=98)	Age <65 years (n=80)	P-value
Total readmissions	72 (73)	44 (55)	0.0190*
Heart failure aggravation	40 (41)	14 (18)	0.0016*
Other cardiovascular reasons	12 (12)	23 (28)	0.0122*
Noncardiovascular readmissions	20 (20)	7 (9)	0.0671
BNP (pg/mL)	345 (214–598)	245 (267–435)	0.425
NT-proBNP (pg/mL)	753 (379–929)	485 (322–973)	0.406
TNF-α (pg/mL)	9.1 (7.6–13.0)	6.2 (4.8–11.0)	<0.0001*
IL-6 (pg/mL)	4.0 (1.9–5.4)	2.2 (1.5–3.0)	0.0001*
hs-CRP (mg/L)	6.6 (3.7–22.2)	2.5 (1.0–2.9)	<0.0001*
MLHFQ score	46 (39–71)	42 (33–64.5)	0.0697
6MWT (m)	255 (185–282)	259 (220–319)	0.0293*
Fahrenberg scale score	8.0 (7.0–10.0)	7.0 (6.0–9.0)	0.0024*

Notes: Categorical variables are presented as number (%). Continuous data are presented as mean ±1 standard deviation when normally distributed and as median (interquartile range) when skewed.

* P-value <0.05.

Abbreviations: HFpEF, heart failure with preserved ejection fraction; BNP, brain natriuretic peptide; NT-proBNP, N-terminal-pro-brain natriuretic peptide; TNF, tumor necrosis factor; IL, interleukin; hs-CRP, high-sensitivity C-reactive protein; MLHFQ, Minnesota living with heart failure questionnaire; 6MWT, 6-minute walk test.

Table 3 Predictors for readmissions in HFpEF patients

Readmissions	Odds ratio	Standard error	P-value	95% CI
Readmissions in HFpEF aged ≥65 years
BNP >450 pg/mL (yes vs no)	0.891	0.047	<0.0001	0.767–0.963
Fahrenberg score >7.4 (yes vs no)	0.713	0.074	0.002	0.565–0.835
6MWT ≤248 m (yes vs no)	0.712	0.087	0.009	0.564–0.834
TNF-α ≥10.1 pg/mL (yes vs no)	0.648	0.085	0.027	0.497–0.780
Readmissions in HFpEF aged <65 years
NYHA class IV (yes vs no)	0.038	1.486	0.027	0.002–0.698
CAD (yes vs no)	2.931	0.517	0.037	1.063–8.079
DM (yes vs no)	5.044	0.536	0.002	1.764–14.423
CKD (yes vs no)	0.703	0.086	0.034	0.502–0.806
Fahrenberg score >7.4 (yes vs no)	0.584	0.229	0.005	0.339–0.832
IL-6 ≥2.5 pg/mL (yes vs no)	2.069	0.250	0.003	1.266–3.38
TNF-α >7.1 pg/mL (yes vs no)	1.584	0.138	<0.001	1.207–2.078
Readmissions due to cardiovascular causes in the elderly HFpEF patients
NT-proBNP >458 pg/mL (yes vs no)	1.002	0.001	0.001	1.001–1.004
Fahrenberg score >7.4 (yes vs no)	1.444	1.346	0.006	1.109–1.880
Readmissions due to HF aggravation in the elderly HFpEF patients
BNP >450 pg/mL (yes vs no)	1.004	0.001	0.007	1.001–1.007
NT-proBNP >477 pg/mL (yes vs no)	1.002	0.008	0.013	1.004–1.003
Readmissions due to HF aggravation in the nonelderly HFpEF patients
BNP >390 pg/mL (yes vs no)	1.002	0.001	0.030	1.003–1.005
TNF-α >7.1 pg/mL (yes vs no)	1.371	0.082	<0.001	1.167–1.610
Readmissions due to other cardiovascular causes in nonelderly HFpEF patients
MLHFQ score >46 (yes vs no)	2.705	0.448	0.041	1.038–7.050
IL-6 >2.1 pg/mL (yes vs no)	0.537	0.313	0.047	0.290–0.993
Readmissions due to noncardiovascular causes in the elderly
TNF-α > 10 pg/mL (yes vs no)	1.300	0.888	0.003	1.092–1.547
Readmissions due to noncardiovascular causes in the nonelderly
IL-6 > 1.9 pg/mL (yes vs no)	0.274	0.627	0.039	0.080–0.940

Abbreviations: HFpEF, heart failure with preserved ejection fraction; BNP, brain natriuretic peptide; 6MWT, 6-minute walk test; TNF, tumor necrosis factor; NYHA, New York Heart Association; CAD, coronary artery disease; DM, diabetes mellitus; CKD, chronic kidney disease; IL, interleukin; NT-proBNP, N-terminal-pro-brain natriuretic peptide; HF, heart failure; MLHFQ, Minnesota living with heart failure questionnaire; CI, confidence interval.

Figure 1 Receiver operating characteristic (ROC) curves for hospital readmission predictors in HFpEF aged ≥65 years.

Abbreviations: HFpEF, heart failure with preserved ejection fraction; BNP, brain natriuretic peptide; 6MWT, 6-minute walk test; TNF, tumor necrosis factor; AUC, area under the curve.

Figure 2 Receiver operating characteristic (ROC) curves for hospital readmission predictors in HFpEF patients aged <65 years.

Abbreviations: HFpEF, heart failure with preserved ejection fraction; DM, diabetes mellitus; TNF, tumor necrosis factor; CAD, coronary artery disease; NYHA, New York Heart Association; IL, interleukin; AUC, area under the curve.

Figure 3 Receiver operating characteristic (ROC) curves for readmissions due to cardiovascular causes in HFpEF patients aged ≥65 years.

Abbreviations: HFpEF, heart failure with preserved ejection fraction; NT-proBNP, N-terminal-pro-brain natriuretic peptide; AUC, area under the curve.

Figure 4 Receiver operating characteristic (ROC) curves for readmissions due to heart failure aggravation in HFpEF patients aged ≥65 years.

Abbreviations: HFpEF, heart failure with preserved ejection fraction; BNP, brain natriuretic peptide; NT-proBNP, N-terminal-pro-brain natriuretic peptide; AUC, area under the curve.

Figure 5 Receiver operating characteristic (ROC) curves for readmissions due to heart failure aggravation in HFpEF patients aged <65 years.

Abbreviations: HFpEF, heart failure with preserved ejection fraction; TNF, tumor necrosis factor; BNP, brain natriuretic peptide; AUC, area under the curve.

Figure 6 Receiver operating characteristic (ROC) curves for readmissions due to other cardiovascular causes in HFpEF patients aged <65 years.

Abbreviations: HFpEF, heart failure with preserved ejection fraction; MLHFQ, Minnesota living with heart failure questionnaire; IL, interleukin; AUC, area under the curve.

Figure 7 Receiver operating characteristic (ROC) curves for readmissions due to noncardiovascular causes in HFpEF patients aged ≥65 years (A) and <65 years (B).

Abbreviations: HFpEF, heart failure with preserved ejection fraction; TNF, tumor necrosis factor; IL, interleukin; AUC, area under the curve.