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Abstract
Introduction We previously presented in-hospital and 30-day post-discharge outcomes for patients admitted with heart failure in our medium-sized district general hospital(1). Here we present 5-year mortality data for the subset of patients defined as having heart failure due to severe valve disease.
Methods Notes and echocardiogram images and reports were reviewed for all patients submitted to the NICOR Heart Failure audit for the year 2015-2016 (1st April-31st March). Patients were classed as having ‘valvular heart failure’ based on assessment of all available previous echocardiograms and from review of admission and clinic notes. They were assessed by two Cardiology training registrars and overseen by a consultant Cardiologist with subspecialty expertise in Heart failure. After 5 years the electronic notes were reviewed to determine how many patients had died since their index admission, and at what point. The dates of death relative to index admission dates were recorded and are shown here.
Patient demographics are shown in table 1:
Number104IHD Documented 35
Mean age83HTN51
Female:Male62:42Diabetes14
NYHA 13COPD18
NYHA 29Mean serum creatinine (mmol/L)124.5
NYHA 337
NYHA 455
Cardiology input96
Results Mortality data are shown in figure 1.
Mortality rates were 37.7% at 6 months, 48.8% at 1 year, 69.9% at 3 years, and 81.9% at 5 years.
Figure 1. VHF mortality curve
Conclusions These real-world data show an elderly cohort of patients with severely symptomatic heart failure (88% NYHA 3/4) due to valve disease. They have a very high mortality over 5 years, but a significant proportion (37.7%) of these patients die within 6 months of a heart failure admission. This highlights the need for early discussions around the appropriateness of valve intervention, keeping patient preference and functional status at the forefront of these discussions.
Where patients prefer not to pursue valve intervention, or are deemed unsuitable, there should be early consideration of involvement of the palliative care team.
Most importantly, the current pressures on the NHS mean that there is a real danger of patients like these dying whilst awaiting potentially life-saving intervention. In an elderly group with such a high mortality, avoiding unnecessary time in hospital should be of high importance. Often tertiary centres cannot offer early enough outpatient dates and therefore many of these patients will wait in hospital for days-weeks for valve intervention. There is a clear need for greater availability of early outpatient valve interventions, and these data highlight that need.
Further work is needed to determine cause of death, and the rates and timing of valve interventions. With progression in TAVI and TEER techniques we would hope to see an improvement in the mortality of future cohorts.
Agreement % for the statements based on the Likert scale
VHF mortality curve
Conflict of Interest None