{
  "abstract": "Introduction Hospitalisation for worsening heart failure (WHF) is a huge burden on UK healthcare resources. There is a growing trend to managing WHF at home or in daycare facilities (9.7% in our 2022 survey) 1 to reduce hospitalization burden. This risks compromising patient care and outcomes, although a UK pilot trial provides some reassurance that this is not the case.2 However, further evidence of longer-term safety is required.Methods Ninety-three patients with WHF for which they received IV diuretics were followed for up to 5 years, of whom 33 had been managed without admission and 60 had been hospitalised. Baseline characteristics including demographics, New York Heart Association (NYHA), renal function, echocardiographic findings were documented. All-cause hospitalisation and mortality at 60 days, 1 year and all follow-up were recorded The primary outcome was all-cause mortality.SPSS Version 28 was used to perform statistical analysis. Mean (SD) or Median [interquartile range] was used to describe continuous variables depending on whether normally distributed or not; and frequency for categorical variables. Kaplan Meir curves were plotted for time to readmission or death.Results By 60 days, a higher mortality was observed in those managed without admission (24 % vs 12%), a difference that persisted at 1 year (52% vs 17%) and for the duration of follow-up (79% vs 25%; log rank P-value = 0.001). [See figure 1]. Hospitalisations were also higher (85% vs 47%, log rank P-value <0.001).Baseline characteristics of patients managed without or with hospital admission were summarised in the (table 1). They have similar age (77 vs 76 years), proportion of women (33% v 45%), proportion in NYHA functional class III or worse (79% and 80%) and with HFrEF (58% vs 65%), at least moderately impaired left ventricular systolic function (39% and 55%), but patients treated without admission had worse renal function (eGFR- 41 [28,54] vs. 59 [34,79], p=0.008).Although it is possible renal function is a confounding variable contributing to excess readmissions and deaths, this study demonstrates the need for meticulous follow-up.Conclusion Management of WHF at home or in day-care facilities is associated with high rates of admission and death when compared with standard inpatient care. A large multicentre randomised trial is needed to determine the safety and effectiveness of managing patients with WHF at home or in day-care facilities. In the meantime, we urge caution for sites developing such services. Careful and responsive follow-up and audit are essential.References Abdullah A, et al. Outpatient-based acute HF care calls for development of clinical psychology service for whole-person care provision. Br J Cardiol 2022;29:141–4.K Wong et al Effectiveness of out-patient based acute heart failure care: a pilot randomised controlled trial. Acta Cardiol. 2023;78:828–837.Abstract 5-023 Table 1Baseline characteristics and heart failure treatment outcomes in outpatient and inpatient settings Outpatient (N=33) Inpatient (N=60) p Age (years) 77 [69,85] 76 [68, 82] 0.6 Gender[number of females (%)] 11(33%) 27 (45%) 0.4 LVSD Preserved Mild Moderate Severe 14 (42%)6 (18%)4 (12%)9 (27%) 21 (35%)6 (10%)11(18%)22 (37%) HFpEF vs HFrEFP=0.5Preserved or mild vsModerate to severeP=0.2 EGFR at admissionMean (SD) 43 (21) 57 (24) 0.008* NYHA I II III IV 07 (21%)19 (58%)7 (21%) 6(10%)6 (10%)20 (33%)28 (47%) NYHA 1 or 2 vs 3 or 4(p=1) All cause mortality 60 days 1 year 8 (24%)17 (52%) 7(12%)10 (17%) Mortality rate (by censor date) 26 (79%) 15 (25%) 0.001 Hospitalisation/readmissionRate (by censor date) 28(85%) 28 (47%) <0.001 Abstract 5-023 Figure 1Home/Day-care based IV diuretic therapy is associated with a higher mortality (log rank p=0.001)",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiology, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK"
      ],
      "name": "Mahendra Nehra"
    },
    {
      "affiliations": [
        "Department of Cardiology, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK"
      ],
      "name": "Omar Assaf"
    },
    {
      "affiliations": [
        "Department of Cardiology, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK"
      ],
      "name": "Nang Latt"
    },
    {
      "affiliations": [
        "Department of Cardiology, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK"
      ],
      "name": "Suzanne Wong"
    },
    {
      "affiliations": [
        "Patient Public Involvement Group, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK"
      ],
      "name": "Grace Wong"
    },
    {
      "affiliations": [
        "Department of Cardiology, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK"
      ],
      "name": "Christopher J Cassidy"
    },
    {
      "affiliations": [
        "Department of Cardiology, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK"
      ],
      "name": "Alison Seed"
    },
    {
      "affiliations": [
        "Ninewells Hospital, Dundee, UK"
      ],
      "name": "Chim Lang"
    },
    {
      "affiliations": [
        "University of Glasgow, UK"
      ],
      "name": "John GF Cleland"
    },
    {
      "affiliations": [
        "Department of Cardiology, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK",
        "Liverpool Centre for Cardiovascular Science, University of Liverpool, UK"
      ],
      "name": "Kenneth Wong"
    }
  ],
  "title": "5-023 Home-management of worsening heart failure with intravenous diuretics is associated with high rates of admission and mortality",
  "uid": "4f5b2e30-c3d6-5a58-a032-bdd86866f407"
}