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
{"title":"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。","authors":"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","doi":"10.1136/openhrt-2025-003432","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481318/pdf/","citationCount":"0","resultStr":"{\"title\":\"Outpatient heart failure specialist care following acute heart failure hospitalisation improves long-term outcomes.\",\"authors\":\"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\",\"doi\":\"10.1136/openhrt-2025-003432\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":19505,\"journal\":{\"name\":\"Open Heart\",\"volume\":\"12 2\",\"pages\":\"\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-09-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481318/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Open Heart\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1136/openhrt-2025-003432\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open Heart","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/openhrt-2025-003432","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Outpatient heart failure specialist care following acute heart failure hospitalisation improves long-term outcomes.
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.
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.
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