A decade of progress in transitional care and 12-month outcomes in acute heart failure: a nationwide comparative analysis of KorAHF and KorHF III registries
H Lee, E S Kim, J C Youn, H S Lee, H Y Lee, S M Kang, D J Choi, B S Yoo, H J ChoAbstract
Background
Patients hospitalised for acute heart failure (HF) face a high-risk "vulnerable phase" following discharge. Despite management advances, it remains uncertain whether real-world outcomes have improved over the past decade and how these trends relate to evolving transitional care processes.
Purpose
To compare outcomes between the historical KorAHF (2011–2014) and contemporary KorHF III (2018–2022) registries, and to evaluate the prognostic association of key transitional care indicators: early follow-up and 1-month guideline-directed medical therapy (GDMT) optimisation.
Methods
We analysed 12,976 adults hospitalised for acute HF (KorAHF n=5,625; KorHF III n=7,351). The primary outcome was a composite of all-cause mortality, heart transplantation, durable ventricular assist device implantation, or HF rehospitalisation. Post-discharge risk disparities were assessed via 90-day landmark analysis. Transitional care was evaluated in discharge survivors using landmark models: (1) early follow-up (outpatient visit within 14 days post-discharge) via 14-day landmark models, and (2) 1-month GDMT optimisation (initiation of new classes, dose uptitration, or attainment of 3 or more classes by 30 days) in discharge-survivor patients with HFrEF (n=6,710) via 30-day landmark models.
Results
In-hospital composite rates declined from 5.9% in KorAHF to 2.9% in KorHF III (HR 0.49; 95% CI 0.42–0.59). Among patients discharged alive (KorAHF n=5,293; KorHF III n=7,137), the 12-month post-discharge composite rate was significantly lower in the contemporary era (49.9% in KorAHF vs 24.0% in KorHF III; aHR 1.89; 95% CI 1.70–2.10 for the historical registry). This excess risk was most pronounced within 90 days post-discharge (90-day landmark aHR 2.21; 95% CI 2.04–2.40). Compared with KorAHF, KorHF III showed higher rates of early 14-day follow-up (63.6% vs 50.6%) and 1-month GDMT optimisation in HFrEF (58.3% vs 35.3%) (both p<0.001). In 14-day landmark models, early follow-up was independently associated with a lower risk of composite events (KorHF III aHR 0.80; KorAHF aHR 0.84) and all-cause mortality (KorHF III aHR 0.7; KorAHF aHR 0.65), but not HF rehospitalisation. In 30-day landmark models, 1-month GDMT optimisation was associated with lower composite events (KorHF III aHR 0.7; KorAHF aHR 0.8) and mortality (KorHF III aHR 0.58; KorAHF aHR 0.6), while HF rehospitalisation was not reduce.
Conclusions
Nationwide acute HF outcomes improved substantially over the last decade, with the greatest gains achieved during the early post-discharge vulnerable phase. These improvements occurred alongside enhanced transitional care; in landmark analyses, early outpatient follow-up and rapid GDMT optimisation were independently associated with lower risks of composite events and mortality.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.