38 * HEART FAILURE IN THE OLDER PERSON: IS THERE STILL A PLACE FOR THE GERIATRICIAN?

Abstract

Background: The National Heart Failure UK Audit (2011/2012) recommends cardiology services should manage in-hospital heart failure, demonstrating better survival outcomes. However frail older peoples' needs were not reflected; cognitive impairment and multi-morbidity were excluded. Our objective was to survey our older patients' characteristics and management for acute heart failure admission.Sampling methods: We sampled forty-five patients admitted to the Older Persons' Unit with heart failure (January-March 2013) collecting data from case notes and discharge summaries, adapting the National Heart Failure Audit tool adding domains including cognition, non-cardiac co-morbidities and dependency.Results: Mean age 86yrs old, mean length of stay 22 days, 62% (28/45) had heart failure with preserved ejection fraction. Most lived alone 62% (28/45). 32% (14/44) scored less than 24/30 on mini-mental state examination. Non-cardiac diseases were common; dementia 22% (10/45), chest disease 22% (10/45), diabetes mellitus 24% (11/45), stroke 18% (8/45), chronic kidney disease 31% (14/45). Admission echocardiography performed in 67% (30/45), brain natriuretic peptide level in 71% (32/45). In patients with reduced ejection fraction, 85% (11/13) were discharged on a beta-blocker. Only 38% (5/13) were discharged on an angiotensin-converting-enzyme inhibitor; of those who were not 50% (4/8) had significant hypotension, 38% (3/8) had significant acute kidney injury.Key conclusions: Cognitive impairment and co-morbidity burden was common. Not everyone received evidence-based medical therapy, mostly clinically justified. Without considering co-morbidity, frailty and medication intolerance, streamlining services to a specialist approach may be detrimental to the complex frail patient. The National Heart Failure Audit should incorporate these aspects to reflect older patients' needs.