Heart failure patients admitted under General Medicine and Cardiology are different.

Authors & Order: Phillipa Brook¹, Andrea Ness², Rhonda Sanders², Belinda Smith^1,2 , David Prior², Hilton Gock¹
Departments of General Medicine¹ & Cardiology², St Vincent’s Hospital Melbourne, Australia

We hypothesised differences in acute decompensated heart failure (ADHF) patients admitted under the General Medicine Unit (GMU) compared to Cardiology Unit (CU) may relate to the burden of co-morbities in GMU patients.

Aim: Examine ADHF admissions to GMU vs CU and describe differences including demographics, clinical features and outcomes.

Method: Consecutive ADHF patients admitted between March–September 2015 were prospectively followed (n=215).  All patients received specialist HF nurse care.

Results: Most admissions were under GMU (71vs29%). GMU patients were older (mean 79vs68yrs), and less spoke English (55vs15%,p<0.0001).  The main precipitant of ADHF in GMU patients was infection (39%) vs ischaemia in CU patients (45%). More patients in GMU had Cor-Pulmonale (12vs2%,p=0.02) and kidney disease (64vs46%,GFR<60ml/min,p=0.0002)).  There was a trend to less ACEi/ARB use (55vs73%,p=0.07) and less use of mineralocorticoid antagonists (29vs71%,p<0.0001) in GMU patients.  Preserved LVEF was seen in 54% of GMU but only 29% of CU patients. Reduced LVEF was seen in 71% of CU but only 45% of GMU patients (p<0.001). GMU patients had more BNP measurements (84vs64%) but a similar rate of echocardiography within 2 years (85vs98%).  GMU patients had shorter LOS with 84vs55% discharged within 10 days.  However, the 30d readmission rate for GMU was 24v15%.  There was no difference in 30d mortality (9%).

Discussion: GMU admits the majority of ADHF patients.  These patients are older, speak less English and have more co-morbidities possibly limiting use of some HF medications. Although having better preserved EF and shorter LOS, the GMU patients have a higher readmission rates.