title: Management and outcomes of congestive heart failure: a prospective study of hospitalised patients.
abstract: OBJECTIVE
  To characterise the morbidity, mortality and patterns of care for patients hospitalised with congestive heart failure (CHF).
  
  
  METHODS
  Prospective cohort study with one-year follow-up.
  
  
  METHODS
  409 patients aged 60 years and over admitted to hospital with congestive heart failure between 1 May and 30 November 1993.
  
  
  METHODS
  John Hunter Hospital (tertiary referral for cardiology) and Mater Hospital (non-tertiary referral for cardiology), Newcastle, New South Wales.
  
  
  METHODS
  Length of hospital stay (LOS); unplanned readmissions; mortality at 28 days and one year; and relationship between outcomes and patient and disease characteristics determined by multivariate analysis.
  
  
  RESULTS
  Annual hospitalisation rate for CHF in the 60 years and over age group was 783/100,000, with CHF accounting for 10.9% of patients in this age group. Median LOS was eight days, and varied significantly between hospitals. ACE inhibitors were being taken by 66% of subjects at discharge. Rate of unplanned readmissions within 28 days was 20%. Mortality was 12.5% at 28 days and 33% at one year. For a first admission for CHF, 28-day mortality was lower than for readmissions (odds ratio, 0.25; 95% confidence interval, 0.1-0.62), and average LOS was 17% lower. Increasing age and renal impairment were significantly associated with higher one-year mortality. Greater comorbidity was associated significantly with longer LOS and non-significantly with higher 28-day and one-year mortality.
  
  
  CONCLUSIONS
  CHF is a common reason for admission, often results in unplanned readmissions, and has a high mortality. Undertreatment with ACE inhibitors continues. The importance of avoiding recurrent admissions was clear. A program of intensive case management may reduce the burden attributable to CHF.
authors.affiliation: Department of General Medicine, John Hunter Hospital, Newcastle, NSW. mdjl@mail.newcastle.edu.au
authors.forename: J M
authors.initials: JM
authors.lastname: Lowe
authors.forename: P M
authors.initials: PM
authors.lastname: Candlish
authors.forename: D A
authors.initials: DA
authors.lastname: Henry
authors.forename: J H
authors.initials: JH
authors.lastname: Wlodarcyk
authors.forename: R F
authors.initials: RF
authors.lastname: Heller
authors.forename: P J
authors.initials: PJ
authors.lastname: Fletcher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome