In patients with heart failure with unplanned admission to hospital lack of improvement in quality-of-life 2 months after discharge identifies individuals at very high risk of readmission or death

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Abstract Background/introduction Unlike mortality which has improved over the last 30 years, hospitalisation and readmission rates in patients with CHF remain stubbornly high. Identifying patients at highest risk after discharge remains a challenge. The patient reported outcome tool, Kansas City Cardiomyopathy Questionnaire (KCCQ) has been widely used to quantify symptom burden, functional status and overall quality of life in patients with CHF. An improvement of 5 or more in the KCCQ is recognised as being clinically meaningful. Purpose We aimed to determine whether a failure to improve KCCQ 2 months after discharge after an unplanned admission is associated with risk of death or readmission. Methods Prospective cohort study of unselected consecutive patients with CHF admitted acutely to secondary care. KCCQ was completed at baseline and 60 days following discharge. A responder was defined as anyone whose 60 days KCCQ score had increased by ≥5 and a non-responder anyone with a change <5. Patient characteristics, vital signs, biochemistry and heart failure therapy were also collected. Results Of 221 patients 184 (83%) patients were responders and 37 (17%) were non-responders. After maximum follow up of 20 months, responders demonstrated an all-cause readmission rate of 29% and 6% all-cause mortality, of non-responders 68% readmitted and 19% died. Non-responders were more likely to die than responders OR 3.7 (95% CI: 1.3 – 10.2; p=0.013) and non-responders were more likely to be re-hospitalised than responders OR 5.1 (95% CI: 2.4 – 11.0; p<0.001). Non-responders were more likely to be female (28% v 46%; p=0.034), have a diagnosis on admission of HFpEF (22% v 49%; p<0.001), have less diagnoses of hypertension (51% v 27%; p=0.009) be diagnosed with COPD (23% v 51%; p<0.001) have a higher LVEF (%) (35.8 ± 13.1 v 43.1 ± 13.9; p=0.003), be less likely to be prescribed SGLT2i (57% v 35%; p=0.017) and have lower SpO2(%) on admission (96.0 ± 2.4 v 95.0 ± 2.9; p=0.024. Conclusion Following an unplanned hospitalisation in patients with CHF failure to improve quality of life is indicative of >70% risk of readmission or death.Table 1.Baseline characteristics Figure 1

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