Management and outcomes of congestive heart failure: a prospective study of hospitalised patients

Abstract

Objectives To characterise the morbidity, mortality and patterns of care for patients hospitalised with congestive heart failure (CHF). Design Prospective cohort study with one‐year follow‐up. Patients 409 patients aged 60 years and over admitted to hospital with congestive heart failure between 1 May and 30 November 1993 Setting John Hunter Hospital (tertiary referral for cardiology) and Mater Hospital (non‐tertiary referral for cardiology), Newcastle, New South Wales. Outcome measures Length of hospital stay (LOS); unplanned readmissions; mortality at 28 days and one year; and relationship between outcomes and patient and disease characteristics determined by multivariate analysis. Results Annual hospitalisation rate for CHF in the 60 years and over age group was 783/100000, with CHF accounting for 10.9% of patients in this age group. Median LOS was eight days, and varied significantly between hospitals. ACE inhibitors were being taken by 66% of subjects at discharge. Rate of unplanned readmissions within 28 days was 20%. Mortality was 12.5% at 28 days and 33% at one year. For a first admission for CHF, 28‐day mortality was lower than for readmissions (odds ratio, 0.25; 95% confidence interval, 0.1‐0.62), and average LOS was 17% lower. Increasing age and renal impairment were significantly associated with higher one‐ year mortality. Greater comorbidity was associated significantly with longer LOS and non‐significantly with higher 28‐day and one‐year mortality. Conclusions CHF is a common reason for admission, often results in unplanned readmissions, and has a high mortality. Undertreatment with ACE inhibitors continues. The importance of avoiding recurrent admissions was clear. A program of intensive case management may reduce the burden attributable to CHF.