Long‐term survival and life expectancy following an acute heart failure hospitalization in Australia and New Zealand

AIMS: Contemporary long‐term survival following a heart failure (HF) hospitalization is uncertain. We evaluated survival up to 10 years after a HF hospitalization using national data from Australia and New Zealand, identified predictors of survival, and estimated the attributable loss in life expectancy. METHODS AND RESULTS: Patients hospitalized with a primary diagnosis of HF from 2008–2017 were identified and all‐cause mortality assessed by linking with Death Registries. Flexible parametric survival models were used to estimate survival, predictors of survival and loss in life expectancy. A total of 283 048 patients with HF were included (mean age 78.2 ± 12.3 years, 50.8% male). Of these, 48.3% (48.1–48.5) were surviving by 3 years, 34.1% (33.9–34.3) by 5 years and 17.1% (16.8–17.4) by 10 years (median survival 2.8 years). Survival declined with age with 53.4% of patients aged 18–54 years and 6.2% aged ≥85 years alive by 10 years (adjusted hazard ratio [aHR] for mortality 4.84, 95% confidence interval [CI] 4.65–5.04 for ≥85 years vs. 18–54 years) and was worse in male patients (aHR 1.14, 95% CI 1.13–1.15). Prior HF (aHR 1.20, 95% CI 1.18–1.22), valvular and rheumatic heart disease (aHR 1.11, 95% CI 1.10–1.13) and vascular disease (aHR 1.07, 95% CI 1.04–1.09) were cardiovascular comorbidities most strongly associated with long‐term death. Non‐cardiovascular comorbidities and geriatric syndromes were common and associated with higher mortality. Compared with the general population, HF was associated with a loss of 7.3 years in life expectancy (or 56.6% of the expected life expectancy) and reached 20.5 years for those aged 18–54 years. CONCLUSION: Less than one in five patients hospitalized for HF were surviving by 10 years with patients experiencing almost 60% loss in life expectancy compared with the general population, highlighting the considerable persisting societal burden of HF. Concerted multidisciplinary efforts are needed to improve post‐hospitalization outcomes of HF.