46 Place of care and specialist follow up are the main determining factor for outcome in patients admitted with acute heart failure. (June 2018)

• Record Type: Journal Article
• Authors: Al-Refaie, Norildin; Phillips, Michael; Ashton, Moira; Lucas-Jones, Sarah; Wong, Aaron
• Is Part Of: Heart. Volume 104(2018)Supplement 6
• Page Start: A43
• Page End: A43
• Publication Date: 2018-06
• Subjects: Heart Failure -- Specialist input -- Mortality rate; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2018-BCS.46
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Introduction: Acute heart failure (AHF) is associated with high mortality rates. UK national heart failure audit has highlighted higher in-patient mortality in patients who were managed by non-specialists. Purpose: Compare in-patient mortality rates with 30 days, 6 months and 1 year mortality rates based on place of care, and determine the effect of specialist follow up. Method: Retrospective analysis of data on 250 patients who were discharged with the primary diagnosis of heart failure from year 2014–2015. Results: Inpatient mortality rate was significantly lower if patients were treated in the cardiology ward compared to other medical wards. (13% vs 23%, p value=0.03) 30 days, 6 months and 1 year mortality rates were not significantly different based on place of care, although the trend still shows preference to the patients who were managed in the cardiac ward. (30 days: 21.5% vs 25%, p value=0.3) (6 months: 32% vs 43%, p value=0.07) (1 year: 39% vs 46%, p value=0.16) Patients who were managed in cardiology ward were more likely to be followed up by specialists in the community (table 1). And patients who were followed up by HF specialists, regardless of the place of care were associated with significantly lower 6 months and 1 year mortality rates (6 months: 20% vs 35%, p value=0.04. 1 year: 26% vs 42%, p value=0.037) Demographic data, co-morbidities, investigations and medications are shown in the table below. Conclusions: In-patients mortality rate is significantly lower in AHF patients managed in cardiology ward despite the presence of more significant co-morbidities. Similarly, specialist follow up was associated with lower mortality post discharge. These findings are likely to be attributed to better optimisation of evidence based medicines, more comprehensive assessment, and patients monitoring. This study highlighted that importance of specialist input in the management of such complex condition.