{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:45:10Z","timestamp":1790790310279,"version":"4.1.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2018,1,4]],"date-time":"2018-01-04T00:00:00Z","timestamp":1515024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Psychosocial factors are rarely collected in studies investigating the prognosis of patients with heart failure (HF), and only time to first event is commonly reported. We investigated the prognostic value of psychosocial factors for predicting first or recurrent events after discharge following hospitalization for HF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>OPERA-HF is an observational study enrolling patients hospitalized for HF. In addition to clinical variables, psychosocial variables are recorded. Patients provide the information through questionnaires that include social information, depression and anxiety scores, and cognitive function. Kaplan\u2013Meier, Cox regression and the Andersen\u2013Gill model were used to identify predictors of first and recurrent events (readmissions or death). Of 671 patients (age 76\u2009\u00b1\u200915\u2009years, 66% men) with 1-year follow-up, 291 had no subsequent event, 34 died without being readmitted, 346 had one or more unplanned readmissions, and 71 patients died after a first readmission. Increasing age, higher urea and creatinine, and the presence of co-morbidities (diabetes, history of myocardial infarction, chronic obstructive pulmonary disease) were all associated with increasing risk of first or recurrent events. Psychosocial variables independently associated with both the first and recurrent events were: presence of frailty, moderate-to-severe depression, and moderate-to-severe anxiety. Living alone and the presence of cognitive impairment were independently associated only with an increasing risk of recurrent events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Psychosocial factors are strongly associated with unplanned recurrent readmissions or mortality following an admission to hospital for HF. Further research is needed to show whether recognition of these factors and support tailored to individual patients' needs will improve outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.1112","type":"journal-article","created":{"date-parts":[[2018,1,4]],"date-time":"2018-01-04T10:27:45Z","timestamp":1515061665000},"page":"689-696","source":"Crossref","is-referenced-by-count":92,"title":["Prognostic Value of Psychosocial Factors for First and Recurrent Hospitalizations and Mortality in Heart Failure Patients: Insights from the OPERA-HF Study"],"prefix":"10.1093","volume":"20","author":[{"given":"Ioanna","family":"Sokoreli","sequence":"first","affiliation":[{"name":"Philips Research \u2013 Healthcare , Eindhoven ,","place":["The Netherlands"]},{"name":"Department of Public Health, Centre for Medical Decision Making, Erasmus MC , Rotterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen C.","family":"Pauws","sequence":"additional","affiliation":[{"name":"Philips Research \u2013 Healthcare , Eindhoven ,","place":["The Netherlands"]},{"name":"TiCC - University of Tilburg , Tilburg ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewout W.","family":"Steyerberg","sequence":"additional","affiliation":[{"name":"Department of Public Health, Centre for Medical Decision Making, Erasmus MC , Rotterdam ,","place":["The Netherlands"]},{"name":"Department of Medical Statistics and Bioinformatics, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gert-Jan","family":"de Vries","sequence":"additional","affiliation":[{"name":"Philips Research \u2013 Healthcare , Eindhoven ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jarno M.","family":"Riistama","sequence":"additional","affiliation":[{"name":"Philips Research \u2013 Healthcare , Eindhoven ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Tesanovic","sequence":"additional","affiliation":[{"name":"Philips Research \u2013 Healthcare , Eindhoven ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed","family":"Kazmi","sequence":"additional","affiliation":[{"name":"University of Hull , Hull ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierpaolo","family":"Pellicori","sequence":"additional","affiliation":[{"name":"University of Hull , Hull ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G.","family":"Cleland","sequence":"additional","affiliation":[{"name":"University of Hull , Hull ,","place":["UK"]},{"name":"National Heart & Lung Institute, Imperial College , London ,","place":["UK"]},{"name":"Robertson Centre for Biostatistics & Clinical Trials, University of Glasgow , Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew L.","family":"Clark","sequence":"additional","affiliation":[{"name":"University of Hull , Hull ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,1,4]]},"reference":[{"key":"2026011721225653400_ejhf1112-bib-0001","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1002\/ehf2.12021","article-title":"Improving care for patients with acute heart failure: before, during and after hospitalization","volume":"1","author":"Cowie","year":"2014","journal-title":"ESC Heart Fail"},{"key":"2026011721225653400_ejhf1112-bib-0002","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1001\/archinte.168.13.1371","article-title":"Statistical models and patient predictors of readmission for heart failure: a systematic review","volume":"168","author":"Ross","year":"2008","journal-title":"Arch Intern Med"},{"key":"2026011721225653400_ejhf1112-bib-0003","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s11606-012-2235-x","article-title":"Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: systematic review","volume":"28","author":"Calvillo-King","year":"2013","journal-title":"J Gen Intern Med"},{"key":"2026011721225653400_ejhf1112-bib-0004","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s10741-015-9517-4","article-title":"Depression and anxiety as predictors of mortality among heart failure patients: systematic review and meta-analysis","volume":"21","author":"Sokoreli","year":"2016","journal-title":"Heart Fail Rev"},{"key":"2026011721225653400_ejhf1112-bib-0005","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.ijcard.2016.06.068","article-title":"Depression as an independent prognostic factor for all-cause mortality after a hospital admission for worsening heart failure","volume":"220","author":"Sokoreli","year":"2016","journal-title":"Int J Cardiol"},{"key":"2026011721225653400_ejhf1112-bib-0006","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1157\/13124994","article-title":"Prognostic implication of frailty and depressive symptoms in an outpatient population with heart failure","volume":"61","author":"Lup\u00f3n","year":"2008","journal-title":"Rev Esp Cardiol"},{"key":"2026011721225653400_ejhf1112-bib-0007","first-page":"1110","article-title":"Identification and use of frailty indicators from text to examine associations with clinical outcomes among patients with heart failure","volume":"2016","author":"Shao","year":"2016","journal-title":"AMIA Annu Symp Proc"},{"key":"2026011721225653400_ejhf1112-bib-0008","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1053\/euje.4.1.36","article-title":"Effect of age and sex on left atrial morphology and function","volume":"4","author":"Nikitin","year":"2003","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026011721225653400_ejhf1112-bib-0009","doi-asserted-by":"crossref","first-page":"2353","DOI":"10.1093\/eurheartj\/ehl233","article-title":"The diagnostic utility of N-terminal pro-B-type natriuretic peptide for the detection of major structural heart disease in patients with atrial fibrillation","volume":"27","author":"Shelton","year":"2006","journal-title":"Eur Heart J"},{"key":"2026011721225653400_ejhf1112-bib-0010","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The Hospital Anxiety and Depression Scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr Scand"},{"key":"2026011721225653400_ejhf1112-bib-0011","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1002\/gps.1167","article-title":"Characteristics of the GPCOG, a screening tool for cognitive impairment","volume":"19","author":"Brodaty","year":"2004","journal-title":"Int J Geriatr Psychiatry"},{"key":"2026011721225653400_ejhf1112-bib-0012","first-page":"387","article-title":"Balance in elderly patients: the \u2018get-up and go\u2019 test","volume":"67","author":"Mathias","year":"1986","journal-title":"Arch Phys Med Rehabil"},{"key":"2026011721225653400_ejhf1112-bib-0013","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1016\/S0140-6736(02)08594-X","article-title":"Survival plots of time-to-event outcomes in clinical trials: good practice and pitfalls","volume":"359","author":"Pocock","year":"2002","journal-title":"Lancet"},{"key":"2026011721225653400_ejhf1112-bib-0014","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1214\/aos\/1176345976","article-title":"Cox's regression model for counting processes: a large sample study","volume":"10","author":"Andersen","year":"1982","journal-title":"Ann Stat"},{"key":"2026011721225653400_ejhf1112-bib-0015","doi-asserted-by":"crossref","DOI":"10.1201\/b11826","volume-title":"Flexible imputation of missing data","author":"van Buuren","year":"2012"},{"key":"2026011721225653400_ejhf1112-bib-0016","doi-asserted-by":"crossref","DOI":"10.1002\/9780470316696","volume-title":"Multiple imputation for nonresponse in surveys","author":"Rubin","year":"1987"},{"key":"2026011721225653400_ejhf1112-bib-0017","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/S0006-3223(02)01423-3","article-title":"Depression as a risk factor for non-suicide mortality in the elderly","volume":"52","author":"Schulz","year":"2002","journal-title":"Biol Psychiatry"},{"key":"2026011721225653400_ejhf1112-bib-0018","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1001\/archpsyc.56.10.889","article-title":"Minor and major depression and the risk of death in older persons","volume":"56","author":"Penninx","year":"1999","journal-title":"Arch Gen Psychiatry"},{"key":"2026011721225653400_ejhf1112-bib-0019","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1093\/oxfordjournals.aje.a010262","article-title":"Cognitive impairment and mortality in the community-dwelling elderly","volume":"151","author":"Bassuk","year":"2000","journal-title":"Am J Epidemiol"},{"key":"2026011721225653400_ejhf1112-bib-0020","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1001\/jama.279.8.585","article-title":"Risk factors for 5-year mortality in older adults: the Cardiovascular Health Study","volume":"279","author":"Fried","year":"1998","journal-title":"JAMA"},{"key":"2026011721225653400_ejhf1112-bib-0021","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1111\/j.1532-5415.2006.00745.x","article-title":"Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society\/National Institute on Aging Research Conference on Frailty in Older Adults","volume":"54","author":"Walston","year":"2006","journal-title":"J Am Geriatr Soc"},{"key":"2026011721225653400_ejhf1112-bib-0022","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1093\/eurjhf\/hft050","article-title":"EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot)","volume":"15","author":"Maggioni","year":"2013","journal-title":"Eur J Heart Fail"},{"key":"2026011721225653400_ejhf1112-bib-0023","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1016\/j.amjcard.2011.12.026","article-title":"Predicting outcome in patients with left ventricular systolic chronic heart failure using a nutritional risk index","volume":"109","author":"Al-Najjar","year":"2012","journal-title":"Am J Cardiol"},{"key":"2026011721225653400_ejhf1112-bib-0024","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s00392-017-1082-5","article-title":"Prognostic value of simple frailty and malnutrition screening tools in patients with acute heart failure due to left ventricular systolic dysfunction","volume":"106","author":"Sze","year":"2017","journal-title":"Clin Res Cardiol"},{"key":"2026011721225653400_ejhf1112-bib-0025","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1007\/s11897-013-0139-7","article-title":"How are depression and Type D personality associated with outcomes in chronic heart failure patients?","volume":"10","author":"Widdershoven","year":"2013","journal-title":"Curr Heart Fail Rep"},{"key":"2026011721225653400_ejhf1112-bib-0026","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1016\/j.jacc.2010.03.068","article-title":"Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial","volume":"56","author":"O'Connor","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"2026011721225653400_ejhf1112-bib-0027","doi-asserted-by":"crossref","first-page":"h638","DOI":"10.1136\/bmj.h638","article-title":"Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease","volume":"350","author":"Coventry","year":"2015","journal-title":"BMJ"},{"key":"2026011721225653400_ejhf1112-bib-0028","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1016\/j.ejheart.2006.11.001","article-title":"Cognitive impairment in heart failure: a systematic review of the literature","volume":"9","author":"Vogels","year":"2007","journal-title":"Eur J Heart Fail"},{"key":"2026011721225653400_ejhf1112-bib-0029","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1093\/eurjhf\/hfq042","article-title":"Does cognitive impairment predict poor self-care in patients with heart failure?","volume":"12","author":"Cameron","year":"2010","journal-title":"Eur J Heart Fail"},{"key":"2026011721225653400_ejhf1112-bib-0030","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/1741-7015-11-65","article-title":"A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial","volume":"11","author":"Cameron","year":"2013","journal-title":"BMC Med"},{"key":"2026011721225653400_ejhf1112-bib-0031","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.arr.2011.11.002","article-title":"Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and\/or multi-morbidity: a meta-analysis","volume":"11","author":"de Vries","year":"2012","journal-title":"Ageing Res Rev"}],"container-title":["European Journal of Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fejhf.1112","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/20\/4\/689\/66269838\/eurjhf_20_4_689.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/20\/4\/689\/66269838\/eurjhf_20_4_689.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T02:25:32Z","timestamp":1768703132000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjhf\/article\/20\/4\/689\/8414782"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,4]]},"references-count":31,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2018,1,4]]},"published-print":{"date-parts":[[2018,4,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ejhf.1112","relation":{},"ISSN":["1388-9842","1879-0844"],"issn-type":[{"value":"1388-9842","type":"print"},{"value":"1879-0844","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,4]]},"published":{"date-parts":[[2018,1,4]]}}}