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Introduction: Early physician follow-up after hospital discharge for acute decompensated heart failure (ADHF) is recommended by the AHA to prevent early hospital readmission. This recommendation has not been specifically evaluated for heart failure with preserved ejection fraction (HFpEF). Hypothesis: Earlier follow-up should lead to decrease in readmissions for ADHF in the HFpEF population even when adjusting for confounding factors. Methods: Consecutive ADHF hospitalisation that occurred inclusively between 2015 and 2018 were reviewed. Main inclusion criterion was left ventricular ejection fraction ≥45%. The major exclusion criteria were: severe valvulopathy, hypertrophic cardiomyopathy, acute coronary syndrome 3 months before hospitalisation, chronic kidney failure (eGFR <30 ml/min), severe chronic respiratory disease and death before discharge. Follow-up delay after discharge was dichotomized (early vs late/no follow up) by using the median delay. Main outcome was hospital readmission in the year following discharge. Multivariate logistic regression was performed for main outcome according to follow-up delay and adjusted for age, sex, medication at discharge and major comorbid conditions. Results: A total of 163 heart failure readmission (37% of patients) occurred in 438 patients in the year following the first hospitalisation. Median readmission delay was of 62 days. Median dedicated follow-up delay was 30 days and was arranged in 68% of cases. After adjusting for confounding variables, early follow-up was significantly associated with fewer readmission (adjusted odds ratio 0.57, 95% CI; 0.34-0.97). Conclusions: Early dedicated follow-up after discharge for HFpEF was associated with fewer readmission over the year following discharge even when adjusting for major confounding variables.

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PurposeCurrently there is no UK consensus on fitness to fly in congenital heart patients. Evidence for the need for supplemental oxygen during flights for cardiac patients is limited. We review our use of a hypoxia challenge testing (HCT) to simulate aeroplane conditions and advise patients on fitness to fly and the requirement for supplemental oxygen.MethodsWe reviewed all paediatric patients with cardiac conditions referred for a hypoxic challenge test since introduction of the test in 2016. Using a purpose built box this mimics the environmental drop in oxygen availability observed during a flight at high altitude. Patient saturations continuously monitored over a 20 min period.ResultsWe reviewed 11 patients over a 1 year period. The mean age was 78.2 months (range 8–285 months). The mean weight was of 26.5 kg (range 8.1–86.4 kg). Average baseline saturation was 86% (range 79% – 99%).Of the 11, 10 had some form of cardiac intervention, 9 of which were complex cardiac surgery and of those 6 had a single ventricle repair.4 (36%) of patients were prescribed supplemental oxygen on the basis of testing.ConclusionIn order to establish which patients require supplemental oxygen we recommend HCT to provide objective data. This information is of great help to families and clinicians in planning holidays and often avoiding the need for supplemental oxygen that can be cumbersome and expensive to arrange.

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