HF admission to general wards linked to increased mortality risk
MedWire News: Results from the England and Wales 2008-2009 heart failure (HF) audit indicate that patients with the condition who are admitted to general medicine wards have a higher risk for in-hospital and 1-year mortality than those admitted to cardiology wards.
The overall prognosis of patients hospitalized with HF is not only poor, but "substantially worse than data from clinical trials suggest," say the authors of the audit, published in the journal Heart.
This, they explain, "may reflect the [effect of the] exclusion of older, frail, and multimorbid patients and/or the survival benefit that appears to accrue from participating in clinical trials."
The HF audit consisted of monthly analyses of the investigations and treatments given to the first 10 HF patients admitted to 86 national hospitals between April 2008 and March 2009. Lengths of stay and mortality rates were also assessed among the 6170 patients (median age 78 years; 43% female) included in the audit.
The authors report that less than 50% of patients showed diagnostic HF signs at presentation, with 30% and 43% exhibiting shortness of breath at rest and ankle edema, respectively.
Important investigations, namely, echocardiogram and measurement of left ventricular ejection fraction (LVEF) and B-type natriuretic peptide (BNP), were not always performed.
Specifically, echocardiograms and LVEF measurements were carried out 75% of the time, and BNP measurements (recommended by the National Institute for Clinical Excellence as a choice investigation for HF) were performed in only 1% of all patients.
In-hospital mortality occurred at an overall rate of 12%, with a 1.9-fold higher risk for in-hospital death observed among patients admitted to general medicine wards (46%) compared with those admitted to cardiology wards (45%), after adjustment for confounders such as age and comorbidity (p<0.001).
Projected mortality risk at 1 year was also higher among patients treated on a general ward compared with those treated on a cardiology ward, with a hazard ratio of 1.4 (p<0.001).
John Cleland (University of Hull, UK) and team say that "more needs to be done to improve the prognosis of patients with HF."
They suggest: "Re-organization of existing resources, rather than new funding, will be key to success."
The authors conclude: "Hopefully future iterations of this audit will demonstrate sustained improvements in the quality of care, resulting in improved survival."
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By Lauretta Ihonor