TY - JOUR
T1 - Heart Failure Specialist Care and Long-Term Outcomes for Patients Admitted With Acute Heart Failure
AU - CVD-COVID-UK/COVID-IMPACT Consortium
AU - Cannata, Antonio
AU - Mizani, Mehrdad A.
AU - Bromage, Daniel I.
AU - Piper, Susan E.
AU - Hardman, Suzanna M.C.
AU - Sudlow, Cathie
AU - de Belder, Mark
AU - Scott, Paul A.
AU - Deanfield, John
AU - Gardner, Roy S.
AU - Clark, Andrew L.
AU - Cleland, John G.F.
AU - McDonagh, Theresa A.
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024
Y1 - 2024
N2 - Background: For patients with acute heart failure (HF), specialist HF care during admission improves diagnosis and treatments. Objectives: The authors aimed to investigate the association of HF specialist care with in-hospital and longer term prognosis. Methods: The authors used data from the National Heart Failure Audit from January 1, 2018, to December 31, 2022, linked to electronic records for hospitalization and deaths. All-cause mortality was the primary outcome measure and in-hospital mortality the secondary outcome measure. Results: Data for 227,170 patients admitted to hospital with HF (median age: 81 years; IQR: 72-88 years), were analyzed. Approximately 80% of acute HF admissions received support from HF specialists. Thirty-nine percent of patients (n = 70,720) were seen by a multidisciplinary team (HF physicians and HF specialist nurses [HFSNd]), 22% (n = 40,330) were seen by HFSNs alone, and the remaining 39% (n = 71,700) were seen exclusively by specialist HF physicians. At discharge, more patients who received HF specialist care were prescribed medical therapy for HF and had specialized follow-up. Conversely, diuretic agents were prescribed to fewer patients. HF specialist care was independently associated with a higher rate of prescribing HF therapies at discharge and a lower likelihood of receiving diuretic therapy (OR: 0.90 [95% CI: 0.86-0.95]; P < 0.001). HF specialist care was associated with better long-term survival (HR: 0.89 [95% CI: 0.87-0.90]; P < 0.001) and lower in-hospital mortality (OR: 0.92 [95% CI: 0.0.88-0.97]; P < 0.001). Conclusions: Receiving HF specialist care during admission for HF is associated with a higher rate of implementation of medical therapy, fewer discharges on diuretic therapy, and lower in-hospital and long-term mortality across the left ventricular ejection fraction spectrum, especially for patients with heart failure with reduced ejection fraction.
AB - Background: For patients with acute heart failure (HF), specialist HF care during admission improves diagnosis and treatments. Objectives: The authors aimed to investigate the association of HF specialist care with in-hospital and longer term prognosis. Methods: The authors used data from the National Heart Failure Audit from January 1, 2018, to December 31, 2022, linked to electronic records for hospitalization and deaths. All-cause mortality was the primary outcome measure and in-hospital mortality the secondary outcome measure. Results: Data for 227,170 patients admitted to hospital with HF (median age: 81 years; IQR: 72-88 years), were analyzed. Approximately 80% of acute HF admissions received support from HF specialists. Thirty-nine percent of patients (n = 70,720) were seen by a multidisciplinary team (HF physicians and HF specialist nurses [HFSNd]), 22% (n = 40,330) were seen by HFSNs alone, and the remaining 39% (n = 71,700) were seen exclusively by specialist HF physicians. At discharge, more patients who received HF specialist care were prescribed medical therapy for HF and had specialized follow-up. Conversely, diuretic agents were prescribed to fewer patients. HF specialist care was independently associated with a higher rate of prescribing HF therapies at discharge and a lower likelihood of receiving diuretic therapy (OR: 0.90 [95% CI: 0.86-0.95]; P < 0.001). HF specialist care was associated with better long-term survival (HR: 0.89 [95% CI: 0.87-0.90]; P < 0.001) and lower in-hospital mortality (OR: 0.92 [95% CI: 0.0.88-0.97]; P < 0.001). Conclusions: Receiving HF specialist care during admission for HF is associated with a higher rate of implementation of medical therapy, fewer discharges on diuretic therapy, and lower in-hospital and long-term mortality across the left ventricular ejection fraction spectrum, especially for patients with heart failure with reduced ejection fraction.
KW - COVID-19
KW - heart failure
KW - National Heart Failure Audit
KW - specialist care
UR - http://www.scopus.com/inward/record.url?scp=85202009946&partnerID=8YFLogxK
U2 - 10.1016/j.jchf.2024.06.013
DO - 10.1016/j.jchf.2024.06.013
M3 - Article
C2 - 39115521
AN - SCOPUS:85202009946
SN - 2213-1779
JO - JACC: Heart Failure
JF - JACC: Heart Failure
ER -