Non-cardiac admissions most common for heart-failure patients in last year of life
1. In this retrospective analysis of patients with heart failure, admissions to the hospital for non-cardiac problems were more frequent than admissions for heart failure or cardiovascular (CV) disease.
2. The frequency of hospital admissions increased towards the time of death but without change in proportion of admissions for heart failure or CV disease.
Evidence Rating Level: 2 (Good)
Study Rundown: Congestive heart failure (CHF) is a chronic medical condition with a high morbidity and mortality. Despite increases in multidisciplinary team approaches for heart failure management, care of patients towards the end of life is often not prioritized. Efforts to improve care for heart failure patients at the end of life will need to understand the common issues faced by this patient population. This study sought to evaluate the causes of medical decompensation in patients with heart failure in the last year of life. The retrospective analysis found that heart failure and cardiovascular disease were common reasons for hospital admission, but the majority of admissions were for non-cardiac issues. While hospitalization frequency increased towards the time of death, the proportion of admissions for cardiac and non-cardiac causes remained unchanged.
The findings of this study underscore the importance of recognizing non-cardiac issues in patients with end-stage CHF. The main strength of this study is the large cohort of heart failure patients in their final year of life. The limitations of the study include the lack of information on functional class, ejection fraction, and reliance on diagnostic codes for establishing cause of admission.
Click to read the study in JACC: Heart Failure
Relevant Reading: Symptom Relief and Palliative Care during the Last Week of Life among Patients with Heart Failure: A National Register Study
In-Depth [retrospective cohort]: This study is a retrospective cohort analysis of patients in the Danish Central Population Register who received a CHF diagnosis from 2000 to 2015 and were started on heart failure therapy with angiotensin-converting enzyme inhibitors (ACEIs)/ angiotensin receptor blockers (ARBs) and beta blockers within 4 months after the diagnosis. Patients were excluded if they died after 2016 or had lived less than one year with a heart failure diagnosis. International Classification of Diseases and Related Health Problems 10 (ICD-10) diagnostic codes were used to establish heart failure diagnosis, presence of comorbidities, and reason for hospital admissions within 1 year of death.
The study found that of the 32,157 heart failure patients, 84% (n=26 561) were hospitalized at least one time in the year leading up to their death. Reasons for hospital admission included heart failure (12%, n=9 644), other CV causes (18%, 14 738) and non-CV related disease (64%, 51 696). Hospitalizations increased in frequency closer to the time of death but the proportion of admissions for non-CV causes did not change significantly.
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