Poles apart, but are they the same? A comparative study of Australian and Scottish patients with chronic heart failure

This paper reports on an international comparison of the characteristics, t reatment and health outcomes of chronic heart failure (CHF) patients discha rged from acute hospital care in Australia and Scotland. The baseline chara cteristics and treatment of 200 CHF patients recruited to a randomised stud y of a non-pharmacological intervention in Australia and 157 CHF patients c oncurrently recruited to a similar study in Scotland were compared. Subsequ ent health outcomes (including survival and readmission) within 3 months of discharge in those patients who received usual post-discharge care in Aust ralia (n = 100) and Scotland (n = 75) were also compared. Individuals in bo th countries were predominantly old and frail with significant comorbidity likely to complicate treatment. Similar proportions of Australian and Scott ish patients were prescribed either a 'high' (20 vs. 18%) or medium (64 vs. 66%) dose of an angiotensin-converting enzyme inhibitor. Proportionately m ore Australian patients were prescribed a long-acting nitrate, digoxin and/ or a beta -blocker. At 3 months post-discharge, 57 of the 100 (57%: 95% CI 47-67%) Australian and 37 of the 75 (49%: 95% CI 38-61%) Scottish patients assigned to 'usual care' remained event-free (NS). Similarly, 15 vs. 12% re quired greater than or equal to2 unplanned readmission (NS) and 16 vs. 19% of Australian and Scottish patients, respectively, died (NS). Australian an d Scottish patients accumulated a median of 0.6 vs. 0.9 days, respectively, of hospitalisation/patient/month (NS). On multivariate analysis (including country of origin), unplanned readmission or death was independently corre lated with severe renal impairment (adjusted odds ratio 4.4, P < 0.05), a p revious hospitalisation for CHF (2.3, P < 0.05), longer index hospitalisati on (2.7 for > 10 days, P < 0.05) and greater comorbidity (1.3 for each incr emental unit of the Charlson Index, P = 0.05). Health outcomes among predom inantly old and frail CHF patients appear to be independent of the health-c are system in which the patient is managed and more likely to be dependent on the syndrome itself. (C) 2001 European Society of Cardiology. All rights reserved.