Introduction Acute heart failure (AHF) is associated with 9% mortality. The National heart failure audit has consistently shown better survival of patients who are under the care of cardiologists. Heart failure mortality is 7% if the patient is in a cardiac ward compared to 11% in other wards. It is unclear whether the mortality benefit is a result of better management such as with disease modifying or are cardiologists selecting patients less ill (younger, better renal function, less severe heart failure). Also we aim to find out whether more patients in cardiac wards get an echocardiography within 48 hours as recommended by NICE guidance.

Methods A retrospective study of consecutive patients admitted in Blackpool Victoria Hospital (BVH) with AHF between August 2019 and January 2021.

Results 630 patients were admitted including 253 patients getting admitted into cardiac wards and 377 admitted into non-cardiac wards. Fourteen (5.5%) patients died during index admission in the cardiac wards and 40 (10.6%) patients died during index admission in the non-cardiac wards [P- 0.029]. The median age for patients in the cardiac wards was younger 75 [64,83] vs 82 [74,88] in non-cardiac wards [P <0.001]. However, patients admitted in cardiac wards had worse renal function- creatinine 108 umol/l [83, 141] vs 97 umol/l [78, 133] [P-0.049]. and worse BNP levels 862 ng/L [466, 1653] vs 587 ng/L [294, 1140] [P <0.001]. Cardiac function in terms of recent Echocardiography finding of Ejection fraction (EF) showed worse baseline cardiac function for patients admitted in cardiac wards 37% vs the 49.5% non-cardiac wards [P<0.001]. 49% of the patients had a previous diagnosis of hypertension compared to 68% patients in non-cardiac wards [P- 0.011].

During hospital admission, 34 % of patients got an echocardiogram. Patients in cardiac wards were more likely to have had an echocardiogram done within 48 hours of admission 45.6% vs 26.9% P <0.001]{Odds ratio 2.3 [95% CI 1.6–3.2]}. Specialist input, irrespective of the place of admission was associated with higher rates of echocardiography.

A higher proportion of patients in cardiac wards were on Angiotensin-converting enzyme inhibitor (ACEi) or Angiotensin receptor blocker (ARB) or Sacubitril/Valsartan (Entresto), Beta blocker, and Mineralocorticoid receptor antagonists (MRA) on discharge. In the cohort whose EF is<40%, significantly more patients discharged from cardiac wards were on MRA(65% vs 39%, P<0.001).

Conclusions These findings show that despite worse renal and cardiac function in terms of BNP and echocardiography LVSD severity, patients had better prognosis in cardiac wards. However, they were younger. There was a greater proportion of male patients. They were less likely to be hypertensive. A higher proportion of patients in cardiac wards were discharged on disease modifying drugs on discharge(e.g. MRA).

Conflict of Interest None