MANAGEMENT AND OUTCOMES OF CONGESTIVE-HEART-FAILURE - A PROSPECTIVE-STUDY OF HOSPITALIZED-PATIENTS

Objectives: To characterise the morbidity, mortality and patterns of c are for patients hospitalised with congestive heart failure (CHF). Des ign: Prospective cohort study with one-year follow-up. Patients: 409 p atients aged 60 years and over admitted to hospital with congestive he art failure between 1 May and 30 November 1993. Setting: John Hunter H ospital (tertiary referral for cardiology) and Mater Hospital (non-ter tiary referral for cardiology), Newcastle, New South Wales. Outcome me asures: Length of hospital stay (LOS); unplanned readmissions; mortali ty at 28 days and one year; and relationship between outcomes and pati ent and disease characteristics determined by multivariate analysis. R esults: Annual hospitalisation rate for CHF in the 60 years and over a ge group was 783/100 000, with CHF accounting for 10.9% of patients in this age group. Median LOS was eight days, and varied significantly b etween hospitals. ACE inhibitors were being taken by 66% of subjects a t discharge. Rate of unplanned readmissions within 28 days was 20%. Mo rtality was 12.5% at 28 days and 33% at one year. For a first admissio n for CHF, 28-day mortality was lower than for readmissions (odds rati o, 0.25; 95% confidence interval, 0.1-0.62), and average LOS was 17% l ower. Increasing age and renal impairment were significantly associate d with higher one year mortality. Greater comorbidity was associated s ignificantly with longer LOS and non-significantly with higher 28-day and one-year mortality. Conclusions: CHF is a common reason for admiss ion, often results in unplanned readmissions, and has a high mortality . Undertreatment with ACE inhibitors continues. The importance of avoi ding recurrent admissions was clear. A program of intensive case manag ement may reduce the burden attributable to CHF.