STUDY OF REPEATED HOSPITALIZATION OF PATIENTS WITH POLYTRAUMA AND CHRONIC HEART FAILURE WITH REDUCED AND PRESERVED EJECTION FRACTION
DOI:
https://doi.org/10.11603/1681-2786.2025.1.15355Keywords:
chronic heart failure; polytrauma; blood loss; hemodynamics; ejection fraction; hypertension; coronary heart disease; intensive care; mortality.Abstract
Cardiovascular morbidity and mortality in patients with chronic heart failure (CHF) are a major problem on health and the economy, especially when readmission rates and length of stay (LOS) are taken into account. As life expectancy increases, the prevalence of CHF continues to increase. Diseases such as diabetes mellitus, hypertension and coronary heart disease continue to be the leading causes of CHF. That CHF is the most common cause of hospitalization in patients over 65 years of age. CHF significantly worsens the prognosis of recovery in patients with combined trauma. Purpose. In this study, we sought to compare the rate of 30-day re-hospitalizations in trauma patients who already had a history of CHF with those who did not have a history of CHF. In addition, we emphasized the influence of different cardiac variables in the CHF group, such as the pathophysiology of CHF (HF with preserved ejection fraction (EF) compared to HF with reduced EF) and the etiology of CHF with EF (ischemic vs. non-ischemic). Materials and methods. Retrospective analysis of 220 patients who were admitted to the intensive care unit between 2017 and 2022 against the background of trauma with an assessment of the severity of the injury. Patients with neurotrauma, children and pregnant women were excluded. Results. The study included 220 patients with trauma, 108 had pre-existing CHF, of which 46 patients had CHF with preserved EF and 62 had HF with reduced EF). 112 patients did not have CHF. 62 cases of CHF with reduced EF, 30 were ischemic in etiology versus 32 non-ischemic. 108 patients with CHF, 24 patients (22.2%) were re-hospitalized within 30 days versus 14 (12.5%) patients without CHF (95% CI: 1.51–2.24, relative risk: 1.84, P at 0.0001). The 24 re-hospitalized patients with HF, 14 had HF with preserved EF and 10 had HF with reduced EF. 30-day rehospitalization and LOS were significantly higher in the ischemic group compared to non-ischemic CHF with reduced EF. Conclusions. In our population, polytrauma patients with CHF had a significantly higher rate of re-hospitalizations within 30 days compared to patients without CHF. The pathophysiology of CHF (HF with preserved EF vs. HF with reduced EF) does not appear to play a role. However, after analyzing the HF subgroups group with reduced EF based on etiology, the outcomes, including mortality, re-hospitalization, and LOS, were significantly higher in the subgroup of ischemic than non-ischemic CHF with reduced EF, which makes this formation more important in the treatment of trauma patients with pre-existing CHF.
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