Overall perceived health predicts risk of hospitalizations and death in adults with heart failure: A prospective longitudinal study

Background: Patient overall perception of health may provide an effective early warning for risk of hospitalization and death among heart failure patients. Objective: Determine whether overall perceived health predicts all-cause hospitalization or death in heart failure patients after adjusting for confounding factors in a sample of adults with heart failure. Design: Prospective, longitudinal, observational study. Settings: Three outpatient urban settings in the northeast United States between 2007 and 2010. Participants: Adults with chronic Stage C heart failure confirmed by echocardiographic and clinical evidence. Methods: A secondary analysis was conducted using data collected on 273 Stage C patients with heart failure. Participants in the parent study were followed for 6 months. Overall perceived health was measured by self-report. Hospitalization and death were assessed from electronic hospital records and confirmed with county death records as needed. Cox proportional hazards models were used to examine the association between perceptions of health and rates of hospitalization and death. Results: Patients with poor or fair perceived health had over 5.5 times the rate of death or hospitalization over the 6-month period (hazard ratio; 95% confidence interval: 2.0-15.6; p = 0.001) after controlling for model covariates. The predictive ability of perceived health attenuated over time such that at 30-days patients who reported poor or fair perceived health had only 1.2 times the rate of an event and virtually no difference in event rate by 60-days. Conclusions: Overall perceived health is a powerful indicator of impending events and can be a quick tool for prioritizing heart failure patients who are at highest risk of imminent death and hospitalization. Questions about perceived health need to be asked of patients regularly in order to have clinical utility. (C) 2012 Elsevier Ltd. All rights reserved.