Outpatient heart failure specialist care following acute heart failure hospitalisation improves long-term outcomes.

IF 2.8 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Open Heart Pub Date : 2025-09-29 DOI:10.1136/openhrt-2025-003432

Jonathan Raby, Hesham Aggour, Manju George, Hannah Glatzel, Benjamin Fidock, Molly Winter, Karmen Quek, Saul Federman, Josephine Chaplin, Mari Kononen, Nicola Bowers, Andrew Money-Kyrle, Norman Qureshi, Rodney De Palma, Soroosh Firoozan, Punit Ramrakha, Piers Clifford, Mayooran Shanmuganathan

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Abstract

Background: Hospitalisation with acute heart failure (AHF) carries a high risk of death, and those surviving to discharge remain at high risk of death or rehospitalisation with AHF. The impact of outpatient heart failure (HF) specialist care after discharge from AHF hospitalisation on longer-term outcomes is unclear in contemporary UK practice.

Methods: A retrospective analysis of a cohort of 2104 patients admitted to hospital due to AHF between 2014-2022 in a single UK county was performed. Patient characteristics, left ventricular ejection fraction (EF) (LVEF) category (HF with reduced EF (LVEF ≤40%; HFrEF), HF with mildy reduced EF (LVEF 41%-49%; HFmrEF) and HF with preserved EF (LVEF ≥50%; HFpEF)) and survival free from a composite end point of AHF rehospitalisation or death are described. Cox regression survival analysis was performed to explore the impact of baseline patient characteristics and HF specialist care on long-term outcomes.

Results: The median age of the cohort was 83 years. HFrEF was present in 36%, HFmrEF in 9% and HFpEF in 55%. 13% died during index AHF hospitalisation. Median follow-up for those surviving to discharge was 618 (IQR 264-1275) days. 21% were rehospitalised due to AHF, and 63% died during follow-up. On adjusted survival analysis of 1511 patients with echocardiogram data available, HF specialist care after discharge from hospital was independently associated with a significant reduction in the composite end point across all LVEF categories (HFrEF: HR 0.577, 95% CI 0.429 to 0.775, p<0.001; HFmrEF: HR 0.485, 0.281-0.834, p=0.009; HFpEF HR 0.762, 0.623-0.931, p=0.008).

Conclusions: HF specialist care after discharge for patients hospitalised with AHF is associated with a significant reduction in the long-term risk of rehospitalisation and all-cause death. This association was present across the three LVEF categories (HFrEF, HFmrEF and HFpEF) and was independent of age and important comorbidities.

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急性心力衰竭住院后的门诊心力衰竭专科护理可改善长期预后。

背景：因急性心力衰竭（AHF）住院的患者存在较高的死亡风险，存活至出院的患者仍然存在因急性心力衰竭而死亡或再次住院的高风险。在当代英国的实践中，AHF住院出院后门诊心力衰竭（HF）专科护理对长期预后的影响尚不清楚。方法：回顾性分析2014-2022年间英国某郡因AHF住院的2104例患者。描述了患者特征、左心室射血分数（EF）（LVEF）类别（EF降低的HF （LVEF≤40%;HFrEF）、EF轻度降低的HF （LVEF 41%-49%; HFmrEF）和EF保留的HF (LVEF≥50%;HFpEF)）以及无AHF再住院或死亡复合终点的生存期。进行Cox回归生存分析，探讨基线患者特征和心衰专科护理对长期结局的影响。结果：队列的中位年龄为83岁。HFrEF占36%，HFmrEF占9%，HFpEF占55%。13%在AHF住院期间死亡。存活至出院的中位随访时间为618 （IQR 264-1275）天。21%因AHF再次住院，63%在随访期间死亡。对1511例有超声心动图数据的患者进行了调整后的生存分析，出院后的HF专科护理与所有LVEF类别的复合终点的显著降低独立相关（HFrEF: HR 0.577, 95% CI 0.429至0.775）。结论：住院AHF患者出院后的HF专科护理与再住院和全因死亡的长期风险显著降低相关。这种关联存在于三种LVEF类别（HFrEF、HFmrEF和HFpEF）中，与年龄和重要合并症无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Open Heart CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.60

自引率

3.70%

发文量

145

审稿时长

20 weeks

期刊介绍： Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.