1. In this retrospective analysis of patients with heart failure, admissions to the hospital for non-cardiac problems were more frequent than admissions for heart failure or cardiovascular (CV) disease.
2. The frequency of hospital admissions increased towards the time of death but without change in proportion of admissions for heart failure or CV disease.
Evidence Rating Level: 2 (Good)
Study Rundown: Congestive heart failure (CHF) is a chronic medical condition with a high morbidity and mortality. Despite increases in multidisciplinary team approaches for heart failure management, care of patients towards the end of life is often not prioritized. Efforts to improve care for heart failure patients at the end of life will need to understand the common issues faced by this patient population. This study sought to evaluate the causes of medical decompensation in patients with heart failure in the last year of life. The retrospective analysis found that heart failure and cardiovascular disease were common reasons for hospital admission, but the majority of admissions were for non-cardiac issues. While hospitalization frequency increased towards the time of death, the proportion of admissions for cardiac and non-cardiac causes remained unchanged.
The findings of this study underscore the importance of recognizing non-cardiac issues in patients with end-stage CHF. The main strength of this study is the large cohort of heart failure patients in their final year of life. The limitations of the study include the lack of information on functional class, ejection fraction, and reliance on diagnostic codes for establishing cause of admission.