Heart patients likely to die if admitted to general wards
Women fared worse than men when it comes to proper investigations and treatment although death rates were similar, found the national heart failure audit for England and Wales published online in the journal Heart.
According to the report, heart failure accounted for more than a quarter of a million hospital deaths and discharges in England and Wales in 2006-07, equating to around 2.5 million bed days a year and at an annual cost to the NHS of 563 million pounds.
The authors draw their conclusions from a survey of the first 10 patients admitted each month with a primary diagnosis of heart failure to 86 hospitals across England and Wales between April 2008 and March 2009.
During this period, just over 6,000 patients, with an average age of 78, were admitted with the condition. Almost half of these (43 per cent) were women.
At admission, less than a third, or 30 per cent, were reported to be breathless at rest and under half (43 per cent) as having swollen feet/ankles. These are both diagnostic features of heart failure.
Appropriate investigations were not always carried out, the survey showed, with those admitted to general medical wards less likely to receive these than those admitted to cardiology wards.
Most patients (75 per cent) were given a heart trace monitor test (echocardiogram). But only two thirds of those (65 per cent) admitted to general medical wards were given this test.
This showed that the left ventricular ejection fraction (LVEF), an indicator of the pump action of one of the two lower chambers of the heart, was 40 per cent or less in most of those admitted.
But LVEF was not recorded in one in four patients. And those with an LVEF of under 40 per cent or in whom LVEF was not recorded were more likely to be women, older, and managed on general medical wards.
Levels of natriuretic peptides, which are a much effective test for heart failure, and a much better barometer of likely outcome than LVEF, were only measured in one per cent of patients, the authors noted.
Half the patients were admitted to cardiology wards. Compared with those managed on general wards, they tended to be younger and were more likely to be men.
Those admitted to general medical wards were twice as likely to die as those admitted to cardiology wards, even after taking account of other risk factors.