Heart Failure Patients in General Wards Have Worse Prognosis
Heart failure patients in general wards twice as likely to die as those in cardiac wards
THURSDAY, Jan. 27 (HealthDay News) -- Patients with heart failure who are admitted to general hospital wards are at an increased risk of mortality compared to those admitted to cardiology wards, according to a study published online Dec. 20 in Heart.
John G.F. Cleland, M.D., of the University of Hull in the United Kingdom, and colleagues surveyed the first 10 patients hospitalized with a primary diagnosis of heart failure each month in 86 hospitals providing services for acute medical admissions in England and Wales from April 2008 until March 2009.
At admission, the investigators found that 30 percent of patients were breathless at rest and 43 percent presented with swollen feet/ankles. Echocardiograms were recorded in 75 percent of patients and left ventricular ejection fraction (LVEF) was ≤40 percent in 78 percent. However, only 65 percent of those admitted to general medical wards were given an echocardiogram and LVEF was not recorded in one of four patients. In addition, natriuretic peptides were rarely measured. More than 90 percent of patients were treated with loop diuretics at discharge, 80 percent with angiotensin-converting enzyme inhibitors, 50 percent with β-blockers, and 30 percent with aldosterone antagonists. Even after adjusting for differences, patients admitted to general medicine wards were more likely to die than those admitted to cardiology wards (hazard ratio, 1.9).
"The prognosis of patients hospitalized with heart failure remains poor and investigation and treatment suboptimal," the authors write. "Specialist services are associated with higher rates of investigation and treatment and improved outcome."