Heart failure admission to a cardiology department versus other internal medicine department is associated with improved long-term survival

Abstract

Abstract Background Hospitalization for heart failure (HF) is associated with a high risk of in-hospital mortality, but also poor long-term outcomes. Although most hospital systems aim to admit patients with HF to cardiology departments, a significant proportion is admitted to other internal medicine departments due to shortages of beds and limited resources. The prognostic importance of being admitted to different departments is unknown. Purpose To compare the long-term mortality rate in patients admitted to hospital with a first diagnosis for HF to a cardiology department versus other internal medicine departments at a large academic hospital in Norway with a catchment area of 560,000 individuals. Methods Adult patients with a first ICD-10 diagnosis of HF (I11.0, I13.0, I13.2, I42.x, I50.x) admitted to an internal medicine department at our University Hospital between 2011 and 2019 were included. All-cause mortality was obtained from the Norwegian Cause of death registry until December 31, 2021. Results In total, we included 7,692 patients aged 76.1±13.0 years, of whom 46.0% were women, 57.4% had hypertension, 24.1% diabetes, 47.0% established coronary artery disease (CAD) and 36.0% a previous acute myocardial infarction (AMI). Of these, 50.7% were admitted to the cardiology department, 13.5% to the pulmonary department, 7.6% to the infectious disease department and the rest to other internal medicine departments. Patients admitted to the cardiology department were younger and more frequently men with established heart disease. They were more frequently examined with echocardiography during the first 30 days after admission, but had comparable levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) to those admitted to other departments (Table 1). During mean 5.9 years of follow-up, 56.6% of patients died. Patients admitted to the cardiology department had 37% lower mortality risk compared to other departments (HR 0.63 [95% CI 0.59–0.66], p<0.001). This association persisted after adjusting for age, sex, comorbidities (listed in the Table), NT-proBNP and undergoing echocardiographic examination (HR 0.75 [0.70–0.80], p<0.001). Having an echocardiographic examination was also associated with lower mortality risk in the same multivariable model (HR 0.92 [95% CI 0.86–0.97], p<0.001). Conclusion Admission to a cardiology department with HF is associated with better long-term outcomes compared to admission to other internal medicine departments. These findings support health care policy efforts to expand capacity at cardiology departments to allow best care for these vulnerable patients. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was in part funded by research grants from Novartis.