AimsThe aim of the current study is to examine 10 year trends in mortality and readmission following heart failure (HF) hospitalization in metropolitan and regional Australian settings.Methods and resultsWe identified all index HF hospitalizations in the Hunter New England region from 2005 to 2014, using a 10 year ‘look back’ period. The primary endpoint was a composite of all‐cause mortality or all‐cause readmission at 1 year. Secondary endpoints included all‐cause mortality, all‐cause readmission, and HF readmission at 30 days and 1 year. We used logistic regression to explore the predictors of the composite outcome of either all‐cause death or readmission at 1 year. There were 12 114 patients admitted with a first episode of HF between 2005 and 2014, followed up until death or the end of 2015. The mean age was 78 ± 12 years and 49% (n = 5906) were male. A total of 4831 (40%) resided in regional areas and the remainder in metropolitan areas. One hundred sixty‐eight patients (1.4%) were Aboriginal. Approximately 69% of patients had either died or been readmitted for any cause within 12 months of their index event. The 30 day and 1 year all‐cause mortality rates were 13% and 32%, respectively, with no change in the trend over the study period. Age, socio‐economic disadvantage, ischaemic heart disease, renal failure, and chronic lower respiratory disease were predictors of the primary endpoint.ConclusionsHeart failure hospitalizations are followed by high rates of death or readmission. There was no change in this composite endpoint over the 10 year study period.

Obstructive sleep apnoea is highly prevalent in acute coronary syndrome patients eligible for enrolment in cardiac rehabilitation programmes. This condition is an independent predictor of increased morbidity and comorbid conditions in the general population and can lead to an increase in major adverse cardiac events such as revascularization, heart failure and hospital readmission in cardiac patients. There is convincing evidence that treatments such as continuous positive airway pressure or mandibular advancement devices can successfully treat obstructive sleep apnoea and these conditions can be improved or negated resulting in improved cardiac rehabilitation outcomes and improved health related quality of life. Given the potential benefits of obstructive sleep apnoea treatment it would make sense to screen for this condition upon entry to out-patient cardiac rehabilitation programmes. A two-stage approach to screening is recommended, where patients are initially evaluated for the probability of having obstructive sleep apnoea using a brief questionnaire (The STOP-Bang) and then followed up with objective evaluation (portable home monitor or polysomnography) where necessary. Potential barriers to further referral and treatment could be partly mitigated by the training of cardiac rehabilitation staff in sleep disorders and screening.

Summary A pre‐use check to ensure the correct functioning of anaesthetic equipment is essential to patient safety. The anaesthetist has a primary responsibility to understand the function of the anaesthetic equipment and to check it before use. Anaesthetists must not use equipment unless they have been trained to use it and are competent to do so. A self‐inflating bag must be immediately available in any location where anaesthesia may be given. A two‐bag test should be performed after the breathing system, vaporisers and ventilator have been checked individually. A record should be kept with the anaesthetic machine that these checks have been done. The ‘first user’ check after servicing is especially important and must be recorded.