Predictors of re-hospitalization in patients with chronic heart failure

Table 1 Risk stratificatio

	Re-hospitalization risk
Predictors	High risk	Intermediate risk	Low risk
Clinical parameters	3	2	1
Previous hospitalization
Long hospital stay
Age
Sex
Clinical symptoms
Low blood pressure
Comorbid conditions
ICD, ICD firing
QRS prolongation
Elevated heart rate
Serum biomarkers	3	2	1
Impaired renal function
BUN
Persistent hyponatremia
Anemia
Pre-discharge BNP
Cardiac troponin T
Cystatin
Hemodynamic parameters	3	2	1
Pre-discharge elevated E/Ea
IVC > 2.0 cm, collapsibility < 50%
Abnormalities in implantable intracardiac device parameters
Psychosocial parameters	3	2	1
Major depression
Lack of emotional support
Single marital status
No occupation
Race
Education
Poor follow-up
Low income
Intensity of multidisciplinary support/follow-up/therapy/education	3	2	1

All heart failure patients should be risk-stratified based upon the number of predictors present (those with the highest number of predictors would be considered high risk while those with the lowest number would be low risk). 3 denotes patients with the highest risk or re-hospitalization; 2 denotes an intermediate risk; 1 denotes the lowest risk. While all heart failure patients require comprehensive, multidisciplinary support, the intensity should be adjusted according to their risk of re-hospitalization. 3 denotes that high risk patients should receive the highest intensity of support; 1 denotes that patients with the lowest risk of re-hospitalization should receive lowest intensity of support; and 2 denotes that intermediate risk patients should get intermediate intensity support relative to the highest and lowest risk patients. Also etiology of re-hospitalization must be taken into consideration when customizing intervention to the individual patient. BNP: B-type natriuretic peptide; E/Ea: Early diastolic velocity/tissue Doppler early diastolic mitral annular velocity; IVC: Inferior vena cava; BUN: Blood urea nitrogen; ICD: Implantable cardioverter-defibrillator.