Article Text

  1. H Alkhawam1,
  2. A Al-khazraji1,
  3. S Ahmad1,
  4. JJ Lieber1,
  5. R Madanieh2,
  6. TJ Vittorio2,
  7. M El-Hunjul3
  1. 1Internal Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), Corona, New York, United States
  2. 2St. Francis Hospital – The Heart Center®, Roslyn, New York, United States
  3. 3Internal Medicine, Present Saint Joseph Hospital, Chicago, New York, United States


Background Cardiovascular morbidity and mortality in heart failure (HF) patients comprise a major health and economic burden, especially when readmission rate and length of stay are considered. With increasing life expectancy, HF prevalence continues to increase. Diseases such as diabetes mellitus, hypertension and ischemic heart disease continue to be the leading causes of HF. Current data suggests that HF is the most common cause for hospital admission in patients older than 65 years.

Objective In this study, we sought out to compare the morbidity, mortality, 30-day readmission rate and length of stay in trauma patients who have a pre-existing history of HF to those who do not have a history of HF. Additionally, we emphasize the effect of different cardiac variables in the HF group such as the pathophysiology of HF (HF with preserved ejection fraction [HFpEF] vs. HF with reduced ejection fraction [HFrEF]) and the etiology of HFrEF (ischemic vs. nonischemic).

Methods A retrospective chart analysis of 8,137 patients who were admitted to our hospital between 2005–2013 secondary to trauma with an Injury Severity Score<30. Data was extracted using ICD-9 codes. Neurotrauma patients were excluded.

Results Of 8,137 trauma patients, 334 had pre-existing HF, of which 169 had HFpEF while 165 had HFrEF). Of the 165 HFrEF cases, 121 were ischemic in etiology vs. 44 nonischemic. Of 334 patients, 81 patients (24%) were readmitted within 30 days vs. 1,068 (14%) of the non-HF patients (95% CI 1.52–2.25, RR: 1.85, p<0.0001). Of the 81 readmitted HF patients, 64 had HFpEF while 35 had HFrEF. There was no statistical significance observed in any of the endpoints in the HFpEF versus. HFrEF groups (figure 1 and table 1). Mortality, 30-day readmission and length of stay were all significantly higher in the ischemic vs. non-ischemic HFrEF group (figure 1 and table 2).

Conclusions In our trauma population, HF patients had a significantly higher morbidity, mortality and 30-day readmission rate when compared to non-HF patients. The pathophysiology of HF (HFpEF vs. HFrEF) did not seem to play a role. However, after subgroup analysis of the HFrEF group based on etiology, all endpoints including mortality, readmission and length of stay were significantly higher in the ischemic HFrEF subgroup rendering this entity higher importance when treating trauma patients with pre-existing HF.

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