Bedside predictors of late prognosis in heart failure with reduced ejection fraction patients surviving hospitalization for acute decompensation

Yıl 2026, Cilt: 31 Sayı: 1 , 89 - 99 , 24.01.2026

Ömer Doğan , Hasan Barman , Abdullah Ömer Ebeoğlu , Adem Atıcı , Sevval Ilke Ebeoglu , Barış Ikıtımur , Sait Mesut Doğan , Rasim Enar

https://doi.org/10.21673/anadoluklin.1763799

https://izlik.org/JA75AF95FE

Öz

Aim: We aimed to identify predictors of mortality and re-admission for worsening heart failure (HF) in patients hospitalized for acute decompensated HF with reduced EF who survived until discharge.

Methods: A total of 767 chronic HF patients with LVEF ≤ 0.40 who were admitted to the hospital for acute decompensation between 2009-2016 and survived until discharge after treatment were enrolled and followed for up to 5 years. The primary end points of the study included cardiovascular death after index hospitalization and re-admission to the hospital for worsening HF.

Results: Primary end points of the study were reached in 40% of cases in the form of cardiovascular death and 71% of cases were re-hospitalized for worsening HF during 5-years follow-up after index hospitalization. After multivariate analysis in cox-regression analysis; NYHA (New York Heart Association) class (p<0.001); LVEF (p=0.005); presence of coronary artery disease (p=0.001); basal sodium levels (p=0.008); moderate-severe mitral regurgitation (p<0.001); the use of high-dose iv furosemide in hospital (p=0.002); inotropic infusion (p=0.030); history of the coronary intensive care unit (p=0.01) and mechanical ventilation (p<0.001); and the development of cardiorenal syndrome (p=0.003) were independent predictors of cardiovascular mortality.

Conclusions: The accumulation of cardiovascular events within the initial 3-6 months after discharge in advanced heart failure patients who survive the initial hospitalization; highlights the significance of the first 6 months as a critical “period of vulnerability” for the implementation of secondary prevention measures.

Anahtar Kelimeler

Heart failure , mortality , prognosis

Etik Beyan

The study protocol was approved by the Ethics Committee of [İSTANBUL ÜNİVERSİTESİ-CERRAHPAŞA REKTÖRLÜĞÜ Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu Başkanlığı] (Approval No: E-74555795-050.04-1344015, Date: 07/05/2025). All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments.

Destekleyen Kurum

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Teşekkür

None

Akut dekompansasyon nedeniyle hastaneye yatırılan ve hayatta kalan düşük ejeksiyon fraksiyonlu kalp yetersizliği hastalarında geç dönem prognozun yatak başı öngörücüleri

https://izlik.org/JA75AF95FE

Öz

Amaç: Akut dekompansasyon ve düşük ejeksiyon fraksiyonu (EF) ile hastaneye yatırılan; taburculuğa kadar hayatta kalan hastalarda mortalite ve kötüleşen kalp yetersizliği nedeniyle tekrar hastaneye yatışın belirleyicilerini tespit etmeyi amaçladık.

Yöntemler: Bu çalışmaya; 2009-2016 yılları arasında akut dekompansasyon nedeniyle hastaneye yatırılan ve tedavi sonrası taburcu edilen; sol ventrikül ejeksiyon fraksiyonu (LVEF) ≤ 0.40 olan toplam 767 kronik kalp yetersizliği hastası dahil edilmiş ve 5 yıl boyunca takip edilmiştir. Çalışmanın birincil sonlanım noktaları; başlangıç hastaneye yatıştan sonra kardiyovasküler ölüm ve kötüleşen kalp yetersizliği nedeniyle hastaneye yeniden yatış olarak belirlenmiştir.

Bulgular: Çalışmada birincil sonlanım noktalarına vakaların %40’ında kardiyovasküler ölüm; %71’inde ise başlangıç hastaneye yatıştan sonraki 5 yıllık takip sürecinde kötüleşen kalp yetersizliği nedeniyle yeniden hastaneye yatış şeklinde ulaşılmıştır. Cox-regresyon analizinde yapılan çok değişkenli analiz sonrası; NYHA sınıfı (p<0.001); LVEF (p=0.005); koroner arter hastalığı varlığı (p=0.001); bazal sodyum düzeyleri (p=0.008); orta-şiddetli mitral yetersizliği (p<0.001); hastanede yüksek doz intravenöz furosemid kullanımı (p=0.002); inotropik infüzyon (p=0.030); koroner yoğun bakım ünitesi geçmişi (p=0.01) ve mekanik ventilasyon (p<0.001); kardiorenal sendrom gelişimi (p=0.003) kardiyovasküler mortalitenin bağımsız belirleyicileri olarak bulunmuştur.

Sonuçlar: İleri evre kalp yetersizliği olan ve ilk hastaneye yatıştan sağ kurtulan hastalarda; kardiyovasküler olayların taburculuktan sonraki ilk 3-6 ay içinde yoğunlaşması; bu ilk 6 ayı; ikincil koruyucu önlemlerin uygulanması için kritik bir “güvenliksiz dönem” olarak vurgulamaktadır.

Anahtar Kelimeler

Kalp yetersizliği , ölüm oranı , prognoz

Etik Beyan

Çalışma protokolü, [İSTANBUL ÜNİVERSİTESİ-CERRAHPAŞA REKTÖRLÜĞÜ Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu Başkanlığı] Etik Kurulu tarafından onaylanmıştır (Onay No: E-74555795-050.04-1344015, Tarih: 07/05/2025). Tüm prosedürler, kurumsal ve/veya ulusal araştırma komitesinin etik standartlarına ve 1964 Helsinki Bildirgesi ile sonraki değişikliklerine uygun olarak gerçekleştirilmiştir.

Destekleyen Kurum

Yazarlar, bu makalenin hazırlanması sırasında herhangi bir fon, hibe veya başka bir destek alınmadığını beyan ederler.

Teşekkür

Yok

Kaynakça

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