Abstract 20076: Short-Term and Long-Term Mortality Rates in Patients With and Without Valvular Heart Disease Who Have Acute Decompensated Heart Failure: An Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Valvular heart disease remains an important cause of heart failure. Studies comparing acute decompensated heart failure (ADHF) associated with valvular disease to other forms of ADHF are limited. We compared mortality rates of patients with acute decompensated valvular heart failure (ADVHF) to those with non-valvular ADHF (ADnVHF). Hypothesis: Mortality differs between ADVHF and ADnVHF. Methods: The Atherosclerosis Risk in Communities (ARIC) study conducted surveillance of hospitalized ADHF patients age ≥55 years in 4 U.S. communities starting in 2005. ADHF hospitalizations were validated by standardized physician review. The prevalence of at least moderate mitral and aortic valvular disease was quantified using in-hospital echocardiograms. In-hospital, 28-day, and 1-year mortality were compared between ADVHF and ADnVHF using logistic regression and adjusted for demographics. Results: From 2005 to 2011, a weighted sample of 15,397 patients was hospitalized for ADHF and had echocardiography data. The ADVHF group was predominantly female (55%), Caucasian (70%), and had a mean age of 76 ± 0.2 yrs. After multivariate adjustment, in-hospital mortality was 30% lower for ADVHF patients compared to those with ADnVHF (OR 0.7, 95% CI 0.5 to 1.0). At 28 days, mortality rates were similar. At 1 year, however, mortality rates were 20% higher for the ADVHF group (OR 1.2, 95% CI 1.0 to 14) (Figure 1). Conclusions: Valvular heart disease is associated with increased risk for 1-year mortality in those hospitalized with heart failure, despite a lower in-hospital mortality in our sample. This suggests that patients with ADVHF have a worse long-term prognosis than those with ADnVHF and may benefit from more intensive follow-up care and aggressive therapy after hospital discharge.