Abstract

Aim: To explore the frequency, causes, and pattern of hospitalisation for patients with chronic HF in the 12 months preceding death. We also investigated cause of death. Methods: Patients referred to a secondary care HF clinic were routinely consented for follow-up between 2001 and 2020 and classified into three phenotypes: i) HF with reduced ejection fraction (HFrEF), ii) HF with preserved ejection fraction (HFpEF) with plasma N-terminal pro B-type natriuretic peptide (NT-proBNP) 125-399 ng.L−1, and iii) HFpEF with NT-proBNP ≥400 ng.L−1. Hospital admissions in the last year of life were classified as: HF, other cardiovascular (CV), or non-cardiovascular (non-CV). The cause of death was systematically adjudicated. Results: 4925 patients (38% women; median age at death 81 [75–87] years) had 9127 hospitalisations in the last year of life. The median number of hospitalisations was 2 (1–3) and total days spent in hospital was 12 (2–25). 83% of patients had ≥ 1 hospitalisation but only 20% had ≥ 1 HF hospitalisation; 24% had ≥ 1 CV hospitalisation; 70% had ≥ 1 non-CV hospitalisation. HF hospitalisations were most common in patients with HFrEF, but in all groups, at least two thirds of admissions were for non-CV causes. There were 788 (16%) deaths due to progressive HF, of which 74% occurred in hospital. Conclusion: For patients with chronic HF in the last year of life, most hospitalisations were for non-CV causes regardless of HF phenotype. Most patients had no HF hospitalisations in their last year of life. Most deaths were from causes other than progressive HF.