15-Year Trends in Patients Hospitalised With Heart Failure and Enrolled in an Australian Heart Failure Management Program

Abstract

Background: Heart failure (HF) is associated with high morbidity and mortality, and is a major contributor to health care costs. Since the area continues to be rapidly evolving, the aim of this study was to examine 15-year trends in demographics, precipitants, symptoms and outcomes of patients hospitalised with HF, and consider the individual and societal implications.

Methods: Data were prospectively collected by Heart Failure nurses from patients enrolled in the Management of Cardiac Function program (MACARF) in Northern Sydney, Australia. Analyses of trends were performed using Mantel-Hanzel tests and one-way analysis of variance. Multivariate Cox proportional hazard models were used to determine changes in readmission and mortality rates.

Results: From 2001 to 2015, 5,588 patients were hospitalised with HF and enrolled in the MACARF program. Over the 15-year period, the average age of enrolled patients increased by a decade (from 74 to 84 years), with an increase in hypertension (52% to 67%), chronic kidney disease (11% to 21%), atrial fibrillation/flutter (29% to 44%), and HF with preserved ejection fraction (24% to 35%) but a decrease in ischaemic heart disease (62% to 47%). Infection and atrial arrhythmias were the two most common precipitants of admission (27% and 18% of patients in 2013-15 respectively), while acute ischaemia became less common, and "unknown" precipitant increased to 35%. While increased exertional dyspnoea and peripheral oedema remained the most common presenting symptoms, weight gain, fatigue and chest pain were less frequently identified. Medication trends included an increase in spironolactone use and a decrease in angiotensin converting enzyme inhibitors. Average length of stay reduced while 1- and 3-year mortality rates improved to 11.3% and 26.6% respectively. In contrast, readmission rates have not improved, with current 30-day and 1-year rates of 9.9% and 42.6%.

Conclusions: Significant temporal changes have occurred in the characteristics and outcome of patients with HF, which pose a challenge and opportunity to improve management. Although length of stay and mortality have improved, unchanged readmission rates highlight the importance of addressing the implications of the changing nature of patients with HF.

Keywords: Decompensation; Heart failure; Trends.