Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Association between the number of hospital admissions and in-hospital outcomes in patients with heart failure

Hypertension Research volume 43, pages 1385–1391 (2020)Cite this article

Abstract

Readmission to the hospital is a major issue in clinical care for patients with heart failure (HF). However, the impact of the number of hospital admissions due to worsened HF is not fully understood. We sought to clarify the association between the number of hospital admissions due to worsened HF and patient outcomes. We studied 331,259 patients (median age was 81 years, and 175,286 patients (52.9%) were men) hospitalized for HF between January 2010 and March 2018 using the Japanese Diagnosis Procedure Combination Database, a national inpatient database. Patients were categorized into five groups based on the number of times they were admitted: once (n = 264,583), twice (n = 42,385), three times (n = 13,205), four times (n = 5347), and five or more times (n = 5739). The patients with larger numbers of admissions were more likely to have comorbidities and to use inotropic agents. The interval period between hospitalizations was shortened with an increasing number of hospital admissions, whereas the length of hospital stay was prolonged with an increasing number of hospital admissions. Multivariable logistic regression analysis fitted with a generalized estimating equation showed that an increased number of hospital admissions was independently associated with higher in-hospital mortality. In conclusion, readmission to the hospital due to worsened HF was still common, and in-hospital mortality was higher in those with larger numbers of readmissions, suggesting a clinical significance of the number of readmissions in patients with HF.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation 2014;129:e28–292.

    Article  Google Scholar 

  2. Gheorghiade M, Vaduganathan M, Fonarow GC, Bonow RO. Rehospitalization for heart failure: problems and perspectives. J Am Coll Cardiol. 2013;61:391–403.

    Article  Google Scholar 

  3. Braunwald E, Bristow MR. Congestive heart failure: fifty years of progress. Circulation. 2000;102(20 Suppl 4):IV14–23.

    CAS  PubMed  Google Scholar 

  4. Jessup M, Brozena S. Heart failure. N Engl J Med. 2003;348:2007–18.

    Article  Google Scholar 

  5. Alcober-Morte L, Barrio-Ruiz C, Parellada-Esquius N, Subirana I, Comin-Colet J, Grau M, et al. Heart failure admission across glomerular filtration rate categories in a community cohort of 125,053 individuals over 60 years of age. Hypertens Res. 2019;42:2013–20.

    Article  CAS  Google Scholar 

  6. Matsushita K, Minamishima T, Sakata K, Satoh T, Yoshino H. Prognostic factors for one-year mortality in patients with acute heart failure with and without chronic kidney disease: differential impact of beta-blocker and diuretic treatments. Hypertens Res. 2019;42:1011–8.

    Article  Google Scholar 

  7. Krumholz HM, Chen YT, Wang Y, Vaccarino V, Radford MJ, Horwitz RI. Predictors of readmission among elderly survivors of admission with heart failure. Am Heart J. 2000;139(1 Pt 1):72–7.

    Article  CAS  Google Scholar 

  8. Kaneko H, Suzuki S, Goto M, Arita T, Yuzawa Y, Yagi N, et al. Incidence and predictors of rehospitalization of acute heart failure patients. Int Heart J. 2015;56:219–25.

    Article  Google Scholar 

  9. Krumholz HM, Parent EM, Tu N, Vaccarino V, Wang Y, Radford MJ, et al. Readmission after hospitalization for congestive heart failure among Medicare beneficiaries. Arch Intern Med. 1997;157:99–104.

    Article  CAS  Google Scholar 

  10. Pocock SJ, Wang D, Pfeffer MA, Yusuf S, McMurray JJ, Swedberg KB, et al. Predictors of mortality and morbidity in patients with chronic heart failure. Eur Heart J. 2006;27:65–75.

    Article  Google Scholar 

  11. Solomon SD, Dobson J, Pocock S, Skali H, McMurray JJ, Granger CB, et al. Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure. Circulation 2007;116:1482–7.

    Article  Google Scholar 

  12. Setoguchi S, Stevenson LW, Schneeweiss S. Repeated hospitalizations predict mortality in the community population with heart failure. Am Heart J. 2007;154:260–6.

    Article  Google Scholar 

  13. Ziaeian B, Fonarow GC. The prevention of hospital readmissions in heart failure. Prog Cardiovasc Dis. 2016;58:379–85.

    Article  Google Scholar 

  14. Akita K, Kohno T, Kohsaka S, Shiraishi Y, Nagatomo Y, Goda A, et al. Prognostic impact of previous hospitalization in acute heart failure patients. Circ J. 2019;83:1261–8.

    Article  Google Scholar 

  15. Tagami T, Matsui H, Fushimi K, Yasunaga H. Prophylactic antibiotics may improve outcome in patients with severe burns requiring mechanical ventilation: propensity score analysis of a japanese nationwide database. Clin Infect Dis. 2016;62:60–6.

    Article  CAS  Google Scholar 

  16. Yagi M, Yasunaga H, Matsui H, Morita K, Fushimi K, Fujimoto M, et al. Impact of rehabilitation on outcomes in patients with ischemic stroke: a nationwide retrospective cohort study in Japan. Stroke 2017;48:740–6.

    Article  Google Scholar 

  17. Shigemi D, Isogai S, Uda K, Aso S, Matsui H, Fushimi K, et al. Association between rehabilitation during hospitalization and perinatal outcomes among pregnant women with threatened preterm birth. J Matern Fetal Neonatal Med. 2019:1–6.

  18. Shakya S, Matsui H, Fushimi K, Yasunaga H. In-hospital complications after implantation of cardiac implantable electronic devices: Analysis of a national inpatient database in Japan. J Cardiol. 2017;70:405–10.

    Article  Google Scholar 

  19. Isogai T, Matsui H, Tanaka H, Fushimi K, Yasunaga H. Seasonal variation in patient characteristics and in-hospital outcomes of Takotsubo syndrome: a nationwide retrospective cohort study in Japan. Heart Vessels 2017;32:1271–6.

    Article  Google Scholar 

  20. Hanley JA, Negassa A, Edwardes MD, Forrester JE. Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol. 2003;157:364–75.

    Article  Google Scholar 

  21. Gheorghiade M, De Luca L, Fonarow GC, Filippatos G, Metra M, Francis GS. Pathophysiologic targets in the early phase of acute heart failure syndromes. Am J Cardiol. 2005;96(6A):11G–7G.

    Article  Google Scholar 

  22. Sato Y, Kuwabara Y, Taniguchi R, Nishio Y, Miyamoto T, Fujiwara H, et al. Malignant link between chronic heart failure and acute cardiac decompensation in patients with persistently increased serum concentrations of cardiac troponin. Int J Cardiol. 2008;126:171–6.

    Article  Google Scholar 

  23. Mann DL, Kent RL, Parsons B, Gt Cooper. Adrenergic effects on the biology of the adult mammalian cardiocyte. Circulation 1992;85:790–804.

    Article  CAS  Google Scholar 

  24. Felker GM, Benza RL, Chandler AB, Leimberger JD, Cuffe MS, Califf RM, et al. Heart failure etiology and response to milrinone in decompensated heart failure: results from the OPTIME-CHF study. J Am Coll Cardiol. 2003;41:997–1003.

    Article  CAS  Google Scholar 

  25. Abraham WT, Adams KF, Fonarow GC, Costanzo MR, Berkowitz RL, LeJemtel TH, et al. In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol. 2005;46:57–64.

    Article  Google Scholar 

  26. Herout PM, Harshaw Q, Phatak H, Saka G, McNeill A, Wu D, et al. Impact of worsening renal function during hospital admission on resource utilization in patients with heart failure. Am J Cardiol. 2010;106:1139–45.

    Article  Google Scholar 

  27. Maeder MT, Rickli H, Pfisterer ME, Muzzarelli S, Ammann P, Fehr T, et al. Incidence, clinical predictors, and prognostic impact of worsening renal function in elderly patients with chronic heart failure on intensive medical therapy. Am Heart J. 2012;163:407–14.

    Article  Google Scholar 

  28. Damman K, Valente MA, Voors AA, O’Connor CM, van Veldhuisen DJ, Hillege HL. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J. 2014;35:455–69.

    Article  Google Scholar 

  29. Yamana H, Moriwaki M, Horiguchi H, Kodan M, Fushimi K, Yasunaga H. Validity of diagnoses, procedures, and laboratory data in Japanese administrative data. J Epidemiol. 2017;27:476–82.

    Article  Google Scholar 

  30. Fonarow GC, Adams KF Jr., Abraham WT, Yancy CW, Boscardin WJ, Adhere Scientific Advisory Committee SG, et al. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA 2005;293:572–80.

    Article  CAS  Google Scholar 

Download references

Funding

This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy-Designated-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141).

Author information

Authors and Affiliations

  1. The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan

    Hidehiro Kaneko, Hidetaka Itoh, Haruki Yotsumoto, Hiroyuki Kiriyama, Tatsuya Kamon, Katsuhito Fujiu, Hiroyuki Morita & Issei Komuro

  2. The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan

    Hidehiro Kaneko & Katsuhito Fujiu

  3. The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan

    Kojiro Morita & Hideo Yasunaga

  4. The Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

    Kojiro Morita

  5. The Department of Health Services Research, The University of Tokyo, Tokyo, Japan

    Nobuaki Michihata & Taisuke Jo

Authors
  1. Hidehiro Kaneko
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hidetaka Itoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Haruki Yotsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroyuki Kiriyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tatsuya Kamon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katsuhito Fujiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kojiro Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nobuaki Michihata
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Taisuke Jo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hiroyuki Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hideo Yasunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Issei Komuro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hidehiro Kaneko.

Ethics declarations

Conflict of interest

Research funding and scholarship funds were received (HK and KF) from Medtronic Japan CO., LTD, Abbott Medical Japan CO., LTD, Boston Scientific Japan CO., LTD, and Fukuda Denshi, Central Tokyo CO., LTD.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kaneko, H., Itoh, H., Yotsumoto, H. et al. Association between the number of hospital admissions and in-hospital outcomes in patients with heart failure. Hypertens Res 43, 1385–1391 (2020). https://doi.org/10.1038/s41440-020-0505-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41440-020-0505-2

Keywords

This article is cited by

Search

Advanced search

Quick links