• Quan Huynh, Kazuaki Negishi, Carmine De Pasquale, James Hare, Dominic Leung, Tony Stanton, and Thomas H Marwick.
• Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS Tom.Marwick@bakeridi.edu.au.
• Med. J. Aust. 2018 Jun 18; 208 (11): 485-491.

ObjectivesTo investigate whether enrolment of patients in management programs after hospitalisation for heart failure (HF) reduces the likelihood of post-hospital adverse outcomes.DesignCohort study in which associations between adverse outcomes at 30 and 90 days for people hospitalised for HF and baseline clinical, socio-demographic and blood pathology factors, and with post-discharge management strategies, were assessed. Setting, participants: 906 patients with HF were prospectively enrolled in five Australian states at cardiology departments with expertise in treating people with HF.Main Outcome MeasuresAll-cause re-admissions and deaths at 30 and 90 days after discharge from the index admission.Results58% of patients were men; the mean age was 72.5 years (SD, 13.9 years). By hospital, 30-day re-admission rates ranged from 17% to 33%, and 90-day rates from 40% to 55%; 30-day mortality rates were 0-13%, 90-day rates 4-24%. Factors associated with increased odds of re-admission or death at 30 or 90 days included living alone, cognitive impairment, depression, NYHA classification, left atrial volume index, and Charlson index score. Nurse-led disease management programs and reviews within 7 days were associated with reduced odds of re-admission (but not of death) at 30 and 90 days; exercise programs were associated with reduced odds at 90 days. Significant between-hospital differences in re-admission rates were reduced after adjustment for post-discharge management programs, and abolished by further adjustment for echocardiography findings. Between-hospital differences in mortality were largely explained by differences in echocardiographic findings.ConclusionsDifferences in early re-admission rates after hospitalisation for HF are primarily explained by differences in post-discharge management.

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