Burden and outcomes of hospitalisation for congestive heart failure

OBJECTIVE: To describe the hospital burden and health outcomes associated with admission for congestive heart failure (CHF). DESIGN AND SETTING: Descriptive follow-up study in a tertiary-level metropolitan teaching hospital. PATIENTS: Acute adult inpatients with a clinical diagnosis of CHF for more than 24 hours admitted to Westmead Hospital, Sydney, during the four months from September 1993 to January 1994. At baseline, 122 patients were assessed; 88 patients were assessed at four-month follow-up. INTERVENTIONS: Usual clinical care. MAIN OUTCOME MEASURES: Length of stay; hospital bed-days; readmissions; mortality; health related quality of life (SF-36); patient knowledge. RESULTS: The average age of subjects was 73.4 years. Many were using informal domiciliary care before admission. Mean length of stay for the baseline admission was 13.8 days, accounting for 7.6% of hospital separations and 1683 hospital bed-days, or 4.2% of bed-days for all inpatients aged 65 years and over. Fifteen patients were readmitted for CHF during the following four months, with a total of 26 CHF-related admissions. Twenty-one patients (17.2%) died during the course of the study. Quality of life at baseline was poor compared with population normative data, with a slight improvement among survivors at four-month follow-up. Patient knowledge of CHF was poor in a subsample survey (n = 24). CONCLUSIONS: CHF represents a significant burden to patients (through morbidity and mortality), their carers (through provision of daily care), and hospitals (through multiple admissions for acute decompensation). It is difficult to monitor the hospital burden of CHF using routine data sources.