Heart failure after hospitalisation: A glimpse of patients referral to health care professionals

Background Heart failure (HF) is a chronic disease with heavy mortality implying a multidisciplinary approach. Aim To precise the different healthcare professionals related to patient's journey after HF hospitalization and impact of referral delay on survival. Methods We used the French SNDS database (Systeme National des Donnees de Sante) to include all hospitalizations with HF as main diagnosis in 2014 in all public and private hospitals of the ex-Champagne-Ardenne region, France, with a retrospective follow-up of three year after discharge. The main end-point was the percentage of referral to health care professionals (HCP). Results A total of 3662 were hospitalized with HF in 2014, in-hospital mortality rate was 8.7% (322). In the 3340 patients discharged alive and included for follow-up, mean age was 80.1 ± 11.3 years, and 1793 (49%) were male. Three-year mortality was high and similar to other registries (50%). Most prevalent comorbidities were atrial fibrillation (53%), hypertension (47%), diabetes (30%), coronary artery disease (24%), chronic kidney disease (24%) and respiratory disease (11%). In the three-year follow-up, less than half of patients consulted a cardiologist (46%). Despite high prevalence and detrimental impact of comorbidities on prognosis, very few consulted other specialists as diabetologist, nephrologist and pneumologist (respectively 3%, 4% and 11%). Pharmacist, general practioner (GP) and nurse were the most consulted, respectively 81%, 76% and 61%. Impact of HCP referral delay on patient survival was heterogeneous ( Table 1 ): negative for GPs and nurses, positive for pharmacists and neutral for cardiologists ( Fig. 1 ). Conclusion After HF hospitalization, patient referral to HCP disease-related remains low, including cardiologists but also other key specialists. Improving HF patients management should emphase the role of first-line professionnals as GPs and nurses but also pharmacists.