Prognosis

Acute heart failure carries an inpatient mortality of 11% overall; in England and Wales there is significant variation between acute hospitals (lowest 6%; highest 26%).[4]

Predictors of adverse outcomes include: hypotension, renal dysfunction, older age, male sex, ischaemic congestive heart failure (CHF), previous CHF, respiratory rate on admission >30/minute, anaemia, hyponatraemia, elevated troponin, elevated B-type natriuretic peptide, and other comorbidities such as cancer.[58]

The National Heart Failure Audit 2020/21, based on data acquired during the coronavirus disease 2019 (COVID-19) pandemic, showed that in-patient mortality (9.2%) and 1-year mortality (39%), was unchanged from 2019/20. Mortality was lower for patients admitted to cardiology (6.0%) compared with general medical (10.2%) wards and for those seen by a specialist (7.9%) compared with those who weren’t (14.9%).[6]

One study found that among patients hospitalised with heart failure, patients across the ejection fraction spectrum have a similarly poor 5-year survival with an elevated risk for cardiovascular and heart failure admission.[59] All patients in this cohort, regardless of ejection fraction, had a remarkably high mortality rate at 5 years from index admission (75.4%).[59]

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