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Objectives: To characterise the morbidity, mortality and patterns of care for patients hospitalised with congestive heart failure (CHF)., Design: Prospective cohort study with one-year follow-up., Patients: 409 patients aged 60 years and over admitted to hospital with congestive heart failure between 1 May and 30 November 1993., Setting: John Hunter Hospital (tertiary referral for cardiology) and Mater Hospital (non-tertiary referral for cardiology), Newcastle, New South Wales., Outcome Measures: Length of hospital stay (LOS); unplanned readmissions; mortality at 28 days and one year; and relationship between outcomes and patient and disease characteristics determined by multivariate analysis., Results: Annual hospitalisation rate for CHF in the 60 years and over age group was 783/100,000, with CHF accounting for 10.9% of patients in this age group. Median LOS was eight days, and varied significantly between hospitals. ACE inhibitors were being taken by 66% of subjects at discharge. Rate of unplanned readmissions within 28 days was 20%. Mortality was 12.5% at 28 days and 33% at one year. For a first admission for CHF, 28-day mortality was lower than for readmissions (odds ratio, 0.25; 95% confidence interval, 0.1-0.62), and average LOS was 17% lower. Increasing age and renal impairment were significantly associated with higher one-year mortality. Greater comorbidity was associated significantly with longer LOS and non-significantly with higher 28-day and one-year mortality., Conclusions: CHF is a common reason for admission, often results in unplanned readmissions, and has a high mortality. Undertreatment with ACE inhibitors continues. The importance of avoiding recurrent admissions was clear. A program of intensive case management may reduce the burden attributable to CHF.

Background: Polymorphic ventricular tachycardia is an uncommon complication of sotalol use., Aims: The aims of this study were: (1) to report five cases of sotalol proarrhythmia and (2) to audit the use of sotalol in a teaching hospital population., Methods: Five patients with sotalol proarrhythmia (defined as new ventricular arrhythmias associated with sotalol administration) were identified over an 18 month period. Sotalol use for patients admitted to the John Hunter Hospital was audited over a six month period with 85 patients (55 males) identified from the pharmacy database. Medical records were reviewed and the details of treatment including sotalol dose and indication determined. Creatinine clearance was estimated by the Cockcroft and Gault regression equation., Results: The audit indicated that sotalol was prescribed predominantly for management of atrial arrhythmias (80%). Paroxysmal atrial fibrillation was the most common indication (71%). Although female patients were older (72 +/- 13 vs 62 +/- 15 years, p < 0.001) and had a lower creatinine clearance (55 +/- = 24 vs 82 +/- = 32 mg/minute, p < 0.001) than male patients, they were prescribed similar doses of sotalol (206 +/- 112 vs 193 +/- 93 mg/day). The ratio of sotalol dose to creatinine clearance was higher in female patients (4.0 +/- 2.6 vs 2.16 +/- 1.5, p < 0.01). The five patients with proarrhythmia (torsades de pointes in four patients and polymorphic ventricular tachycardia in one patient) were all female. Daily sotalol dose (odds ratio for each 160 mg tablet 4.9 [95% confidence interval 1.5-16] and female gender (p < 0.01) were significant risk factors for proarrhythmia., Conclusion: Sotalol dose was not appropriately adjusted for creatinine clearance which is age and gender dependent. Female patients have an increased risk of proarrhythmia and should receive lower doses of sotalol.