P4148Contemporary prognosis of patients hospitalised with a primary diagnosis of heart failure: a report from the national heart failure audit of England & Wales

Abstract

Abstract Background Since 2009, National Health Service hospitals in England & Wales have been required to participate in a national audit of people with a hospital death or discharge attributed primarily to heart failure. The data collection tool is web-based with >250 fields. Mandatory data include age, sex, deprivation-index, admission symptoms, aetiology and co-morbidity, electro- and echo-cardiographic data, standard laboratory tests and discharge medications. Patients are followed up for re-admissions and deaths through linkage to national records. Altogether >500,000 patients have been enrolled. Purpose To describe the contemporary in-patient and post-discharge mortality of patients with a primary death or discharge diagnosis of heart failure reported by hospitals in England & Wales, stratified by age, sex and left ventricular phenotype. Methods Descriptive. Patient characteristics are described as medians with inter-quartile ranges. Time to event analyses using Kaplan-Meier. Results Altogether, 253,981 unique patients (>75% of all relevant admissions) were entered into the registry between April 2014-March 2018, of whom 45% were women (median age of 82 (75–88) years; 45% with LVEF <40%) and 55% were men (median age of 78 (69–85); 65% with LVEF <40%. Amongst 45,772 patients surviving to discharge in 2017–18 with an LVEF <40%, 92% were discharged on a loop diuretic, 22% on digoxin, 72% on an ACE inhibitor, 23% on an ARB, 83% on an ACE inhibitor and/or ARB, 89% on a beta-blocker and 56% on an MRA. Patients who received disease-modifying agents were younger and had a better prognosis. Age, but neither sex nor LVEF, was a strong determinant of both in-patient and post-discharge mortality. In-patient mortality ranged from 3.2% in those aged <45 years to 16.5% in those aged >85 years. One year mortality for patients who survived to discharge ranged from 10.4% in those aged <45 years to 45.6% in those aged >85 years (figure shows age-stratified, post-discharge, one-year mortality for people enrolled 2014–17). Age-Stratified Post-Discharge Mortality Conclusions More than 60% of people hospitalised for heart failure in England & Wales are aged >75 years. In-patient and post-discharge mortality remain high for patients hospitalised with a primary diagnosis of heart failure. Treatment and outcome are strongly influenced by age. Acknowledgement/Funding The Healthcare Quality Improvement Partnership and National Institute for Cardiovascular Outcomes Research funded by UK Government