TY - JOUR
T1 - Management of Acute Decompensated Heart Failure in Rural Versus Metropolitan Settings
T2 - An Australian Experience
AU - Chan, R. Kimberley
AU - Dinh, Diem T.
AU - Hare, David L.
AU - Lockwood, Siobhan
AU - Neil, Chris
AU - Prior, David
AU - Brennan, Angela
AU - Lefkovits, Jeffrey
AU - Carruthers, Harriet
AU - Reid, Christopher M.
AU - Driscoll, Andrea
AU - on behalf of the VCOR-HF Investigators
N1 - Funding Information:
The project was funded by Department of Health and Human Services, Safer Care Victoria, Victorian Cardiac Clinical Network. Professor Andrea Driscoll is supported by a Heart Foundation Future Leader fellowship (100472) from the National Heart Foundation of Australia. Professor Christopher M. Reid is supported by a National Health and Medical Research Council Research Fellowship (1136372). This project would not have been possible without the work done by lead clinical staff, doctors, nurses, data mangers and other hospital staff that contributed data to the project. All their work is gratefully acknowledged.
Publisher Copyright:
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)
PY - 2022/4
Y1 - 2022/4
N2 - Background: Acute decompensated heart failure (ADHF) is the most common cause of hospital admission in patients over 65, with poorer outcomes demonstrated in rural versus metropolitan areas. The aim of this study was to compare the in-hospital and post-discharge management of ADHF patients admitted to rural versus metropolitan hospitals in Victoria. Methods: Data from the Victorian Cardiac Outcomes Registry, Heart Failure (VCOR-HF) project was used. This was a prospective, observational, non-randomised study of consecutive patients admitted to participating hospitals in Victoria, Australia, with ADHF as their primary diagnosis over four 30-day periods during consecutive years. All patients were followed up for 30 days post discharge. Results: 1,357 patients (1,260 metropolitan, 97 rural) were admitted to study hospitals with ADHF during the study periods. Cohorts were similar in age (average 76.87±13.12 years) and percentage of male gender (56.4% overall). Metropolitan patients were more likely to have diabetes (44.4% vs 34.0%, p=0.046), kidney disease (65.8% vs 37.1%, p<0.01) and anaemia (31.9% vs 19.6%, p=0.01). There was no significant difference in length of stay between metropolitan and rural patients (7.49 vs 6.37 days, p=0.12). There was no significant difference between metropolitan and rural patients in 30-day rehospitalisations (19.1% vs 11.6%, p=0.07, respectively) and all-cause 30-day mortality (8.2% vs 4.1%, p=0.15, respectively). Metropolitan patients were significantly more likely to have seen their general practitioner (GP) (68.1% vs 53.2%, p<0.01) or attend an outpatient clinic (35.9% vs 10.6%, p<0.01) by 30 days. There was no significant difference in number of days to follow-up of any kind between groups. Referrals to a heart failure home visiting program remained low overall (19.9%). Conclusion: There was no significant difference in 30-day rehospitalisations or mortality between patients admitted to rural versus metropolitan hospitals. Geographical discrepancies were noted in follow-up by 30 days, with significantly more metropolitan patients having seen a doctor by 30 days post-discharge. Overall follow-up rates remain suboptimal.
AB - Background: Acute decompensated heart failure (ADHF) is the most common cause of hospital admission in patients over 65, with poorer outcomes demonstrated in rural versus metropolitan areas. The aim of this study was to compare the in-hospital and post-discharge management of ADHF patients admitted to rural versus metropolitan hospitals in Victoria. Methods: Data from the Victorian Cardiac Outcomes Registry, Heart Failure (VCOR-HF) project was used. This was a prospective, observational, non-randomised study of consecutive patients admitted to participating hospitals in Victoria, Australia, with ADHF as their primary diagnosis over four 30-day periods during consecutive years. All patients were followed up for 30 days post discharge. Results: 1,357 patients (1,260 metropolitan, 97 rural) were admitted to study hospitals with ADHF during the study periods. Cohorts were similar in age (average 76.87±13.12 years) and percentage of male gender (56.4% overall). Metropolitan patients were more likely to have diabetes (44.4% vs 34.0%, p=0.046), kidney disease (65.8% vs 37.1%, p<0.01) and anaemia (31.9% vs 19.6%, p=0.01). There was no significant difference in length of stay between metropolitan and rural patients (7.49 vs 6.37 days, p=0.12). There was no significant difference between metropolitan and rural patients in 30-day rehospitalisations (19.1% vs 11.6%, p=0.07, respectively) and all-cause 30-day mortality (8.2% vs 4.1%, p=0.15, respectively). Metropolitan patients were significantly more likely to have seen their general practitioner (GP) (68.1% vs 53.2%, p<0.01) or attend an outpatient clinic (35.9% vs 10.6%, p<0.01) by 30 days. There was no significant difference in number of days to follow-up of any kind between groups. Referrals to a heart failure home visiting program remained low overall (19.9%). Conclusion: There was no significant difference in 30-day rehospitalisations or mortality between patients admitted to rural versus metropolitan hospitals. Geographical discrepancies were noted in follow-up by 30 days, with significantly more metropolitan patients having seen a doctor by 30 days post-discharge. Overall follow-up rates remain suboptimal.
KW - Congestive heart failure
KW - HF-pEF
KW - HF-rEF
KW - Readmissions
KW - Regional health
KW - Rural health
UR - http://www.scopus.com/inward/record.url?scp=85119486965&partnerID=8YFLogxK
U2 - 10.1016/j.hlc.2021.08.020
DO - 10.1016/j.hlc.2021.08.020
M3 - Article
AN - SCOPUS:85119486965
SN - 1443-9506
VL - 31
SP - 491
EP - 498
JO - Heart Lung and Circulation
JF - Heart Lung and Circulation
IS - 4
ER -
