Background
Patients admitted to hospital with acute heart failure (AHF) are at increased risk
of readmission and mortality post-discharge. The aim of the study was to examine health
service utilisation within 30 days post-discharge from an AHF hospitalisation.
Methods
This was a prospective, observational, non-randomised study of consecutive patients
hospitalised with acute HF to one of 16 Victorian hospitals over a 30-day period each
year and followed up for 30 days post-discharge. The project was conducted annually
over three consecutive years from 2015 to 2017.
Results
Of the 1,197 patients, 56.3% were male with an average age of 77±13.23 years. Over
half of the patients (711, 62.5%) were referred to an outpatient clinic and a third
(391, 34.4%) to a HF disease management program. In-hospital mortality was 5.1% with
30 day-mortality of 9% and readmission rate of 24.4%. Patients who experienced a subsequent
readmission less than 10 days post-discharge and between 11 and 20 days post-discharge
had a five- to six-fold increase in risk of mortality (adjusted OR 5.02, 95% CI 2.11–11.97;
OR 6.45, 95% CI 2.69–15.42; respectively) compared to patients who were not readmitted
to hospital. An outpatient appointment within 30 days post-discharge significantly
reduced the risk of 30-day mortality by 81% (95% CI 0.09–0.43).
Conclusion
Patients admitted to hospital with AHF who experience a subsequent readmission within
20 days post-discharge are at increased risk of dying. However, early follow-up post-discharge
may reduce this risk. Early post-discharge follow-up is vital to address this vulnerable
period after a HF admission.
Keywords
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References
- National and regional trends in heart failure hospitalization and mortality rates for medicare beneficiaries, 1998-2008.JAMA. 2011; 306: 1669-1678
- Improved survival after heart failure: a community-based perspective.J Am Heart Assoc. 2013; 2: e000053
- Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission.Circ Cardiovasc Qual Outcomes. 2009; 2: 407-413
- Evidence-based practice in ADHF patients admitted to Victorian hospitals.Heart Lung Circ. 2016; 25: S123
- Australia’s health 2010. Australia’s health series no. 12. (Cat. no. AUS 122).AIHW, Canberra2010
- The three-phase terrain of heart failure readmissions.Circ Heart Fail. 2012; 5: 398-400
- Improved outcomes with early collaborative care of ambulatory heart failure patients discharged from the Emergency Department.Circulation. 2010; 122: 1806-1814
- Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure.JAMA. 2010; 303: 1716-1722
- Multidisciplinary strategies for the management of heart failure patients at high risk for readmission: A systematic review of randomised trials.J Am Coll Cardiol. 2004; 44: 810-819
- A snapshot of acute heart failure admissions across New South Wales and the Australian Capital Territory. The NSW HF snapshot study.Med J Aust. 2016; 204: 113
- Survival after an acute heart failure admission. Twelve-month outcomes from the NSW HF Snapshot Study.Heart Lung Circ. 2019. https://doi.org/10.1016/j.hlc.2019.09.004;
- 15 year trends in patients hospitalised with heart failure and enrolled in an Australian heart failure management program.Heart Lung Circ. 2019; 28: 1646-1654
- Transitions of care in heart failure: a scientific statement from the American Heart Association.Circ Heart Fail. 2015; 8
- The relationship between left ventricular systolic function and congestive heart failure diagnosed by clinical criteria.Circulation. 1988; 77: 607-612
- National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of heart failure 2018.MJA. 2018; 27: 1123-1208
- 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.Circulation. 2013; 128: 1810-1852
- Rural-urban differentials in 30-day and 1-year mortality following first-ever heart failure hospitalisation in Western Australia: a population-based study using data linkage.BMJ Open. 2014; 4: e004724
- Evidence-based chronic heart failure management programs: myth or reality.BMJ Quality and Safety. 2011; 20: 31-37
- The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries.J Am Coll Cardiol. 2014; 63: 1123-1133
- Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry.Eur Heart J. 2007; 28: 980-988
- Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE Trial.Arch Intern Med. 2007; 167: 1998-2005
- Rehospitalization for heart failure: problems and perspectives.J Am Coll Cardiol. 2013; 61: 391-403
- Nurse-led titration of angiotensin converting enzyme inhibitors, beta-adrenergic blocking agents, and angiotensin receptor blockers for people with heart failure with reduced ejection fraction.Cochrane Database of Systematic Reviews. 2015; 12: CD009889
- Hospital performance recognition with the Get With The Guidelines Program and mortality for acute myocardial infarction and heart failure.Am Heart J. 2009; 158: 546-553
Article info
Publication history
Published online: April 10, 2020
Accepted:
March 1,
2020
Received in revised form:
January 1,
2020
Received:
August 2,
2019
Identification
Copyright
© 2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
