Survival After an Acute Heart Failure Admission. Twelve-Month Outcomes From the NSW HF Snapshot Study

Background: The New South Wales (NSW) Heart Failure Snapshot sought to provide a contemporaneous profile of patients admitted with acute heart failure. We have previously reported the baseline results, and this paper reports the 30-day and 12-month outcomes. Methods: A prospective audit of consecutive patients admitted to 24 teaching hospitals across NSW and the Australian Capital Territory in July–August 2013 with acute heart failure. Follow-up data were obtained by integration of hospital administrative records and follow-up phone calls with the patients. Results: Eight hundred eleven (811) patients were recruited across the 24 sites. The NSW HF Snapshot was an elderly cohort (77 ± 14 yrs) with high comorbidity (mean Charlson Comorbidity Index 3.5 ± 2.6), and 71% were frail at baseline. Twenty-four per cent (24%) of patients were readmitted within 30-days post discharge. One hundred seventy-eight (178) patients died within 12 months post discharge. The independent predictors of death were frailty (Hazard Ratio 1.98 [95% Confidence interval 1.18–3.30]; p < 0.01) Charlson Comorbidity Index (HR 1.06 [95% CI 1.00–1.13]; p = 0.05); New York Heart Association (NYHA) class 4 (HR 2.62 [95% CI 1.32–5.22]; p < 0.01); eGFR<30 ml/min/1.73 m² (HR 2.16 [95% CI 1.45–3.21]; p < 0.01); hypokalaemia at discharge (HR 2.55 [95% CI 1.44–4.51]; p < 0.01) and readmission within 30 days of baseline admission (HR 2.13 [95% CI 1.49–3.13]; p < 0.01). Conclusion: In one of the largest prospective audits of acute heart failure outcomes in Australia, we found that short-term readmissions and mortality at 12 months remain high but were largely driven by patient-level factors.