157 Readmission for Heart Failure in Rural NSW

Abstract

Specialist services optimise heart failure(HF) outcomes, yet services are difficult to access in regional areas. Hence, rural HF patients are readmitted more frequently than urban patients. Retrospective audit was performed of patients with HF admitted to Orange Health Service(OHS) in 2019. Data was collected from electronic medical records, including readmission within 28 days. There were 179 HF admissions (mean age 77±10.9 years) with LOS 6.5±5.4 days. Admitting teams included Cardiology 132(73.7%), general medicine 34 (19%) and palliative care 13 (7.3%). There were 9(5%) deaths. HF with reduced EF(HFrEF) was present in 91(51%), non-HFrEF in 70(39%) and 15(8.3%) were right heart failure (RHF). Causes for RHF were COPD 20%, ILD 20%, OSA 20%, pulmonary HT 20%, CTEPH 13% and LHF 6%. Echocardiography during admission occurred in 52%. Appropriate therapy, including beta-blocker and a mortality-reducing vasodilator was administered in 63(70%) with HFrEF. Re-admission occurred in 13 patients (8.7%) for a total of 18(10%) encounters. Readmissions were seen in 7(39%) HFrEF, 10(56%) non-HFrEF and 1(6%)RHF respectively. Readmission reasons were HF 9(50%), sepsis 3(17%), renal injury 2(11%), limb ischaemia 2(11%) or other 2(12%). 5(38%) were initially discharged without community linking. There was a significant difference in readmission comparing patients with and without appropriate therapy for HF (OR 0.164 CI 0.078-0.313 p<0.001). Our data showed lower re-admissions rates due to heart failure compared to some series (10%). Those on appropriate therapy were less likely to be readmitted.