Serum Vitamin D Levels Predict 30-day Readmission Rate and Length of Stay in Hospitalized Patients with an Acute Heart Failure Syndrome due to Reduced Ejection Fraction
Journal of Cardiac Failure Vol. 23 No. 8S August 2017
Fadi Ghrair1, Hassan Alkhawam2, Anwar Zaitoun3, Feras Zaiem4, Amir Sara5, David Rubinstein6, Timothy J. Vittorio7; 1Icahn School of Medicine at Mount Sinai (Elmhurst), Astoria, NY; 2Saint Louis University School of Medicine, St. Louis, MO; 3Saint John Hospital and Medical Center, Detroit, MI; 4Mayo Clinic, Rochester, MN; 5Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; 6Icahn School of Medicine at Mount Sinai (Elmhurst), New York, NY; 7St. Francis Hospital—the Heart Center®, Roslyn, NY
- Risk of Cardiac failure reduced 20 percent by 800 IU of vitamin D and Calcium – meta-analysis July 2014
- Chronic Heart Failure improved with 4,000 IU daily for a year – RCT April 2016
- Heart Attack ICU costs reduced $37,000 by $20 of Vitamin D – Nov 2015
- Overview Cardiovascular and vitamin D
Cardiovascular category starts with the following
- Overview Cardiovascular and vitamin D
- Hypertension and vitamin D
- Overview Metabolic Syndrome and vitamin D
- Overview Stroke and vitamin D
- Peripheral arterial disease risk is 1.5X higher if low vitamin D – meta-analysis March 2018
- Peripheral Arterial Disease 3.7 X more likely in diabetics with low vitamin D – June 2019
- Heart attack ICU costs cut in half by Vitamin D – Oct 2018
Meta-analyses
- Heart Failure and Vitamin D meta-analyses - 2016, 2019
- Cardiovascular death 1.5X more likely if less than 20 ng of Vitamin D – 22nd meta-analysis Nov 2019
- Vitamin D supplementation reduces many Cardiovascular Disease markers– meta-analysis July 2018
Omega-3 Helps
- Cardiovascular Prevention with Omega-3 (finally using high doses) – Sept 2019
- Higher Omega-3 index (4 to 8 percent) associated with 30 percent less risk of coronary disease (10 studies) July 2017
A poor Vitamin D Receptor can block Vitamin D in blood from getting to tissues
- Heart Failure 15X more likely if poor VDR, even if good level of vitamin D (China) – March 2019
- Coronary Artery Disease without diabetes 5 times more likely if VDR gene problems – meta-analysis May 2016
Cholesterol, Statins
- Cholesterol is needed to produce both Vitamin D and Cortisol
- Overview Cholesterol and vitamin D
- Statins and vitamin D statins often reduce levels of vitamin D
- Statin side-effects are reduced by Vitamin D – US patent Application – April 2019
Introduction: More than 90% of patients with heart failure with reduced ejection fraction (HErEF) are vitamin D deficient. Lower vitamin D levels have been linked to higher NYHA classes and increased mortality among HFrEF patients. However, data on the relationship between serum vitamin D level and hospitalization are scarce. Our study aims to assess the association of serum vitamin D level with 30-day readmission rate and length of stay (LOS) in patients with acute heart failure (AHF) syndrome due to HFrEF.
Methods: Aretrospective, single-center study of 2,087 patients admitted between January 1, 2005 and December 31, 2014 for an AHF syndrome was performed. Patients without a vitamin D level or measured as 25-dihydroxyvitamin D (25OHD were excluded from our study. 25(OH)D deficiency was defined by having serum concentration levels of less than 20 ng/mL. Normal levels were defined as >30 ng/mL. We assessed levels of 25(OH)D in relation to predicting the 30-day readmission rate, length of stay (LOS) and mortality rate.
Results: Among the 2,087 patients admitted to our hospital for an AHF syndrome, 180 patients had a history of HFrEF and documented levels of vitamin D, of which 42 patients (23.3%) had normal 25(OH)D levels, 83 patients (46.1%) had 25(OH)D deficiency and 55 patients (30.6%) had 25(OH)D insufficiency. The average age of the patients admitted for an AHF syndrome was 62.7 years in HFrEF-25(OH)D deficiency group versus 69.9 years in HFrEF-normal 25(OH)D level (P = .007).
After standardizing medical therapy in each group, the 30-day readmission rate among HFrEF-25(OH)D deficiency was 40% versus 16.6% in HFrEF- normal 25(OH)D level (Odds ratio (OR) 3.4, 95% CI: 1.3-9.3, P = .01). Average LOS among HFrEF-25(OH)D deficiency group was 8.2 days versus 4.1 days in HFrEF- normal 25(OH)D level (P = .04).
Mortality rate did not differ between the two groups. Subgroup analysis among HFrEF-25(OH)D deficiency, average age during the AHF syndrome admission was 60.1 years among male patients versus 67 years in female patients (P = .04). Furthermore, female patients had a higher 30-day readmission rate compared to male patients (26.7% vs 11.8%) with a trend toward statistical significance (P = .07). LOS did not differ between the male and female subgroups (P = .8).
Conclusions: Vitamin D deficiency seems to be a significant independent predictor for an early age of hospitalization, 30-day readmission rate and LOS among HFrEF patients admitted for anAHF syndrome. Further studies are warranted to evaluate vitamin D supplementation on patient outcomes.
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