Hospital admissions in the last year of life of patients with heart failure

Abstract

Abstract 

Aim 

To explore the frequency, causes, and pattern of hospitalisation for patients with chronic HF in the 12 months preceding death. We also investigated cause of death. 

Methods 

Patients referred to a secondary care HF clinic were routinely consented for follow-up between 2001 and 2020 and classified into three phenotypes: i) HF with reduced ejection fraction (HFrEF), ii) HF with preserved ejection fraction (HFpEF) with plasma N-terminal pro B-type natriuretic peptide (NT-proBNP) 125-399 ng.L−1, and iii) HFpEF with NT-proBNP ≥400 ng.L−1. Hospital admissions in the last year of life were classified as: HF, other cardiovascular (CV), or non-cardiovascular (non-CV). The cause of death was systematically adjudicated. 

Results 

4925 patients (38% women; median age at death 81 [75–87] years) had 9127 hospitalisations in the last year of life. The median number of hospitalisations was 2 (1–3) and total days spent in hospital was 12 (2–25). 83% of patients had ≥ 1 hospitalisation but only 20% had ≥ 1 HF hospitalisation; 24% had ≥ 1 CV hospitalisation; 70% had ≥ 1 non-CV hospitalisation. HF hospitalisations were most common in patients with HFrEF, but in all groups, at least two thirds of admissions were for non-CV causes. There were 788 (16%) deaths due to progressive HF, of which 74% occurred in hospital. 

Conclusion 

For patients with chronic HF in the last year of life, most hospitalisations were for non-CV causes regardless of HF phenotype. Most patients had no HF hospitalisations in their last year of life. Most deaths were from causes other than progressive HF.