Heart Failure Specialist Care and Long-Term Outcomes for Patients Admitted With Acute Heart Failure

Long-term outcomes of hospitalised patients with de novo and acute decompensated heart failure

AIMS

Hospital admission for heart failure (HF) is associated with increased mortality risk. Patients admitted with HF can be divided into those with a known previous diagnosis of HF and de novo cases. However, few studies have compared these groups. We compared long-term outcomes of patients with de novo versus acute decompensated HF (ADHF).

METHODS AND RESULTS

We included data from two London hospitals, King's College Hospital and Princess Royal University Hospital. Data from all admissions were collected from the National Institute for Cardiovascular Outcomes and Research (NICOR) National Heart Failure Audit (NHFA) between 2020 and 2021. The outcome measure was all-cause mortality. A total of 561 patients were included in the study. One third (29 %) were de novo hospitalisations. Over a median follow-up of 15 (interquartile range 4-21) months, 257 (46 %) patients died. Hospitalisation for ADHF was associated with higher all-cause mortality during follow-up (51 % vs 34 %, p < 0.001). In adjusted models, hospitalisation for ADHF remained independently associated with higher all-cause mortality during follow-up (HR 0.60, 95 % CI 0.38-0.96; p = 0.03).

CONCLUSION

Amongst patients hospitalised for HF, having a history of HF is associated with a higher risk of all-cause mortality than de novo cases. This may have implications for randomised studies that do not routinely document patients' HF history. Prospective studies are needed to elucidate the risk profiles of these two distinct populations for better risk stratification.

Increasing Access: Reducing Referral Delay in Patients With Ambulatory Advanced HF

BACKGROUND

Referral to advanced heart failure care (AHFC) is advocated to ensure favorable outcomes, and it has been shown to improve prognosis and quality of life in patients at advanced stages of disease. Nevertheless, it may occur later than desired; the rate of eligible patients referred in a timely manner is unknown. We sought to describe the current state of referral for AHFC, highlight potential factors leading to delayed referral and discuss strategies to increase access to AHFC.

METHODS AND RESULTS

We performed electronic searches on Pubmed, EMBASE, Web of Science, and The Cochrane Library to identify studies describing referral patterns to advanced heart failure, patient and provider characteristics associated with increased or decreased referral, settings of care, and associated clinical outcomes. We then discuss possible reasons for referral delay, as well as potential avenues for research and directed intervention to reduce delay and improve patients' outcomes.

CONCLUSION

A referral delay currently exists for AHFC, driven by multiple factors, among them providers' misconceptions about the benefits of AHFC and the appropriate timing of referral, a lack of specialized providers, insufficient and unequal access to care across demographics, and patients' lack of awareness. Efforts to reduce these and other root causes are needed to improve referral rates and optimize outcomes for patients with HF.

Impact of Heart Failure Team on Inpatient Rapid Sequencing of Heart Failure Therapy

The management of heart failure (HF) has undergone a paradigm shift from conventional stepwise methods of initiation and the up-titration of HF therapy towards an early, more intensive initiation of pharmacotherapy to improve the prognosis. The aim of this study was to compare the outcomes of patients at the Liverpool Heart and Chest Hospital (LHCH), with new diagnosis of HF, who were reviewed by the inpatient heart failure team (HFT), compared to patients that were not reviewed. A retrospective review of the electronic records of patients admitted with a new diagnosis of HF to the LHCH from May to December 2023 was performed. Admission drugs were similar, apart from betablockers, which were more frequent in the non-HFT group (58% vs. 24.2%; p = 0.002). The length of inpatient stay was longer in the HFT group (median 5.5 days vs. 3 days; p = 0.001) and more likely to be on all four pillars of HF medical therapy (96.8% vs. 0; p < 0.001) within 30 days of discharge. The 30-day and 6-month mortality outcomes were not significantly different. Patients reviewed by the HFT were significantly more likely to receive the four pillars of HF therapy within 30 days of their diagnosis compared to their counterparts at the expense of a longer length of stay.