Both in- and out-hospital worsening of renal function predict outcome in patients with heart failure: results from the Coordinating Study Evaluating Outcome of Advising and Counseling in Heart Failure (COACH)

Kevin Damman, Tiny Jaarsma, Adriaan A. Voors, Gerjan Navis, Hans L. Hillege*, Dirk J. van Veldhuisen, COACH Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

137 Citations (Scopus)

Abstract

The effect of worsening renal function (WRF) after discharge on outcome in patients with heart failure is unknown.

We assessed estimated glomerular filtration rate (eGFR) and serum creatinine at admission, discharge, and 6 and 12 months after discharge, in 1023 heart failure patients. Worsening renal function was defined as an increase in serum creatinine of > 26.5 mu mol/L and > 25%. The primary endpoint was a composite of all-cause mortality and heart failure admissions. The mean age of patients was 71 +/- 11 years, and 62% was male. Mean eGFR at admission was 55 +/- 21 mL/min/1.73 m(2). In-hospital WRF occurred in 11% of patients, while 16 and 9% experienced WRF from 0 to 6, and 6 to 12 months after discharge, respectively. In multivariate landmark analysis, WRF at any point in time was associated with a higher incidence of the primary endpoint: hazard ratio (HR) 1.63 (1.10-2.40), P = 0.014 for in-hospital WRF, HR 2.06 (1.13-3.74), P = 0.018 for WRF between 0-6 months, and HR 5.03 (2.13-11.88), P <0.001 for WRF between 6-12 months.

Both in- and out-hospital worsening of renal function are independently related to poor prognosis in patients with heart failure, suggesting that renal function in heart failure patients should be monitored long after discharge.

Original languageEnglish
Pages (from-to)847-854
Number of pages8
JournalEuropean Journal of Heart Failure
Volume11
Issue number9
DOIs
Publication statusPublished - Sep-2009

Keywords

  • Worsening renal function
  • Heart failure
  • Prognosis
  • VENTRICULAR SYSTOLIC DYSFUNCTION
  • MYOCARDIAL-INFARCTION
  • CARDIOVASCULAR RISK
  • BROAD-SPECTRUM
  • DISEASE
  • IMPACT
  • CREATININE
  • MORTALITY
  • METAANALYSIS
  • ASSOCIATION

Cite this