A comprehensive study of data from over 233,000 patients, enabled by the BHF Data Science Centre, reveals critical new insights into heart failure hospital admissions. The study sheds light on rehospitalisation and mortality trends, particularly for patients with preserved ejection fraction (HFpEF) and chronic conditions. In the wake of the COVID-19 pandemic, the findings emphasise the need for targeted treatments and improved post-discharge care.
Heart failure is one of the leading causes of hospitalisation and mortality, and has a huge impact on healthcare systems worldwide. There are two major subtypes:
- Heart failure with reduced ejection fraction (HFrEF), which is associated with weakened heart muscles
- Heart failure with preserved ejection fraction (HFpEF), which is linked to the heart’s inability to relax and fill properly
Both these types mean that the heart can’t pump enough blood to meet the body’s needs.
HFpEF is more common and has fewer targeted treatments compared to HFrEF. People with HFpEF are also more likely to live with other long-term health conditions like chronic kidney disease (CKD), diabetes, obesity, and high blood pressure, which can complicate management and negatively affect outcomes. Healthcare inequalities can also contribute to poorer outcomes.
In addition, the COVID-19 pandemic disrupted healthcare delivery for heart failure patients, affecting the rates of rehospitalisation and death, especially for people also living with chronic conditions.
A nationwide view
Researchers at the BHF Data Science Centre (led by HDR UK) analysed electronic health records from 57 million people in England – the largest review of heart failure hospitalisations (by HFrEF and HRpEF) to date.
Using 19 linked data sets, including hospital admissions, medication records and the UK NHFA (National Heart Failure Audit), researchers uncovered key trends in rehospitalisation, mortality, and patient characteristics during and after the COVID-19 pandemic.
They identified 233,320 patients across 335 hospitals who’d survived an initial admission for heart failure between 1 January 2019 and 31 December 2022. These patients were grouped by heart failure subtype, HFrEF (43%), HFpEF (31%) and an unknown subtype (26%). Researchers then tracked their clinical characteristics and outcomes, evaluating changes over time in the causes and rates of rehospitalisation and death within one year of discharge after the initial heart failure hospitalisation, comparing patients with HFrEF to those with HFpEF.
The team explored the impact of chronic conditions like CKD, diabetes, and chronic obstructive pulmonary disease (COPD). They also investigated trends in how treatments were dispensed to patients with a focus on ARN inhibitors, SGLT2 inhibitors, beta blockers, and mineralocorticoid receptor antagonists (MRA), and whether this differed by heart failure type and if a patient had CKD.
Lastly the researchers analysed the impact of the COVID-19 pandemic in terms of disruption to healthcare services, and changes in rehospitalisation and mortality trends during this period.
Key findings
The researchers found that overall rates of rehospitalisation in heart failure patients in England decreased during 2019–2022.
They found that people with HFpEF were more likely to be living with other chronic conditions, and this contributed to a higher rehospitalisation rates overall compared to those with HFrEF. However people with HFrEF had a higher mortality rate from cardiovascular causes than those with HFpEF.
Chronic kidney disease appeared to significantly worsen outcomes for all heart failure classifications, and this might, at least in part, have been due to gaps in the use of recommended treatments like ARN and SGLT2 inhibitors in patients with CKD and heart failure. The researchers suggest these negative effects were amplified by disruption to healthcare delivery during the COVID-19 pandemic, which also contributed to higher overall rates of mortality of any cause.
A path forward beyond the data
While this research used health data from a remarkable 96% of the population of England, the researchers note that the study was observational, meaning they could identify links between different factors, but not the direction of cause and effect. This study emphasises the need for better and more tailored implementation of recommended treatments, especially in vulnerable populations, and more robust strategies to improve outcomes around rehospitalisation and mortality for people with heart failure.
Professor Angela Wood, co-author and theme lead for Whole Population Data at the BHF Data Science Centre, said, “It’s difficult to fully untangle the impact of the COVID-19 pandemic and other health conditions on patient outcomes, as well as the lack of information around quality of life and exactly how medication was being taken.
“The data also only covers people who were admitted to hospital, skewing the findings towards people with more advanced stages of heart failure.
“While heart failure management has improved with the development and delivery of effective therapies, this study calls for improvement in both the application of treatments and a renewed focus on patient outcomes.”
