Heart failure: Hospital admissions in the last year of life

By Dr Jonathan Shurlock
Edited by Dr Ahmed El-Medany

A team led by Dr Alexandra Abel (@alexandraabel) have recently published their work exploring the important topic of admissions in the last year of life for patients with a diagnosis of heart failure. The findings are essential reading for heart failure teams.

The study explored patients who were referred to a secondary care heart failure clinic between 2001 and 2020. Participants were divided into 3 groups: 

  1. HF with reduced ejection fraction (HFrEF)
  2. HF with preserved ejection fraction (HFpEF) and moderately raised BNP (125-399ng/L)
  3. HFpEF with NT-proBNP ≥400ng/L

4,925 patients were included for follow-up, with an average age at death of 81 years. The takeaway finding from the study is that while 83% of participants had at least 1 hospital admission in their last year of life, only 20% of this group had a heart failure related admission. 70% of these admissions were for non-cardiovascular causes. Heart failure hospitalisations were more common in the HFrEF group. During the study period 16% of participants died due to progressive heart failure, with most of these deaths occurring in hospital (74%).

While the authors report that infection was the most common non-cardiovascular cause of hospital admission, they did not further categorise these causes. Given the link between lack of heart failure control and pulmonary infection, the authors suggest that death or hospitalisation related to pulmonary infection should be considered as an outcome measure in future heart failure trials. 

Reported limitations to this study included potential lack of applicability to the full spectrum of heart failure patients, the use of biomarker-based group classification, and limited ability to assess cause of death for those who died outside of a hospital setting. 

Although this work is from a single centre, its findings are useful to inform heart failure teams across the UK. With hospitalisations towards the end of life predominantly being non-cardiovascular, the MDT need to consider the importance of heart failure management in the last years of life, including justifying strict optimisation of heart failure therapies. Considering that most deaths in this group occurred in hospital, the heart failure MDT should have palliative care services embedded where possible, to allow effective advance care planning.

See the full study here: https://pubmed.ncbi.nlm.nih.gov/37553153/