Hospital to community: How Australians with heart failure receive health care

Returning to hospital

In the one year following their index hospitalisation, almost two-thirds of the cohort (64%) were readmitted to hospital for acute care. Six percent of the cohort died without an acute care readmission. 

Twenty-three percent of the cohort had an acute care readmission within 30 days of discharge from their index hospitalisation. Most of these people had an emergency readmission in the 30-day period (87%). 

The proportion of people with at least one emergency readmission increased with age (Figure 13). However, the proportion who had an elective readmission was lowest among people aged 75 and older. 

There was some variation in hospital readmissions by population group. Emergency hospital readmission within one year following hospital discharge was higher among:

• older age groups (46% of those aged less than 50; compared with 61% of those 75 and older)
• Aboriginal and Torres Strait Islander (First Nations) people compared with other Australians (64% or 1,900 people and 57% or 39,300 people respectively)
• those living in Remote and very remote areas (61% or 580 people). Readmissions were lowest among those living in Inner regional areas (55% or 9,500 people)
• those living in the most disadvantaged areas compared with those living in the least disadvantaged areas (60% or 13,000 people and 55% or 4,600 people respectively)
• people aged 75 and over with high level of frailty calculated at index hospitalisation compared to people 75 and over with a lower hospital frailty risk scores (HFRS) category (67% or 13,200 people for high HFRS and 48% or 3,900 people for no/ low HFRS).

People with a heart failure admission prior to the index hospitalisation were more likely to be readmitted for any cause (72%) and have a readmission due to heart failure (principal diagnosis) (27%), when compared to people who had no history of heart failure admissions (any cause: 58%, heart failure (principal diagnosis): 13%).

Reason for readmission

The most common reasons for the first readmission following the index hospitalisation were heart failure (17%), chronic obstructive pulmonary disease (5%), pneumonia (3%) and atrial fibrillation or flutter (3%). 

Emergency department visits

Sixty-five percent of the cohort had at least one emergency department (ED) visit within one year post index hospitalisation, with 40% of these people attending within 30 days. Early contact with the ED may indicate that people were not able to manage their health in the community. 

Almost half (48%) of the cohort had at least one ED attendance that did not lead to a hospital admission. 

Most ED attendances were due to symptoms or conditions other than heart failure. Only 14% of the cohort had an ED visit with a diagnosis (principal, first additional or second additional) of heart failure in the year following the index hospitalisation. Of note, ED attendances may have a symptom, rather than the underlying condition or cause, listed as the diagnosis (for example, chest pain or shortness of breath) (AIHW 2025). This may impact the percentage of the cohort who were identified as having a heart failure related visit. 

First Nations people were more likely to have an ED visit (72% or 2,100 people) when compared to other Australians (65% or 44,700 people). Of people who visited ED, First Nations people were more likely to have at least one visit that did not lead to a hospital admission (63% or 1,300 people) when compared with other Australians (47% or 21,100 people). 

There was also variation by remoteness of usual residence. People living in Remote and very remote areas were less likely to have visited an ED compared with people who lived in Major cities (Figure 14). 

Deaths

Four percent of the cohort died within 1 month of hospital discharge and 24% died within one year. 

The proportion of deaths increased with increasing age (6.5% of those aged less than 50 compared to 30% of those aged over 75). 

Deaths were higher in people with a higher hospital frailty risk score. Of those aged 75 and older, 39% of those with a high frailty risk score died compared to 26% with an intermediate frailty risk score and 18% with a low frailty risk score. 

The proportion of people who died was twice as high among people with an additional diagnosis of heart failure at the index hospitalisation compared with people with a principal diagnosis of heart failure (34% and 16% respectively). People with an additional diagnosis of heart failure at the index hospitalisations were more likely to have high frailty than those with a principal diagnosis of heart failure (44% compared to 33%) (see table S2.24 in supplementary data table). Deaths were higher among people with a history of a heart failure hospitalisation (30%) compared with people who had no prior heart failure hospitalisation (19%). 

Population groups within the cohort that had a younger demographic, including First Nations people and people living in Remote and very remote areas, had a lower proportion of people dying within the year. Of people who lived in Remote and very remote areas 18% died compared to 24% of people who lived in other areas. Similarly, 18% of First Nations people died (520 people) within the year compared to 24% of other Australians. 

Causes of death

More than 2 in 5 (41%) deaths had an underlying cause of cardiovascular disease (CVD). This included: 

• 12% with an underlying cause of heart failure 
• 4.6% with an underlying cause of myocardial infarction (Figure 15).

The most common non-cardiovascular disease (CVD) underlying causes of death in the cohort were:

• Chronic obstructive pulmonary disease (COPD) (ICD-10AM: J40–J44) (9.3%)
• Diabetes (E10–E14) (5.0%) 
• Dementia including Alzheimer's disease (F01, F03, G30) (3.4%)
• Kidney failure (N17–N19) (3.4%)
• Lung cancer (C33, C34) (2.9%). 

Those with a principal diagnosis of heart failure at the index hospitalisation had a higher proportion of deaths due to CVD when compared to those with an additional diagnosis of heart failure only.

Deaths with an underlying cause of heart failure were more common among people who had a prior heart failure hospitalisation, when compared to those with no prior heart failure hospitalisation (15% and 9.2% respectively).