Background and Aims: Outpatient cardiology follow-up is the cornerstone of heart failure (HF) management, requiring adaptation based on patient severity. However, risk stratification using administrative data is scarce, and the association between follow-up and prognosis according to patient risk has yet to be described at a population level. This study aimed to describe prognosis and management across different strata using simple criteria, including diuretic use and prior HF hospitalization (HFH). Methods: This nationwide cohort included all French patients reported as having HF in the previous 5 years and alive on 1 January 2020. Patients were categorized into four groups: (i) HFH within the past year (HFH ≤ 1y), (ii) HFH 1–5 years ago (HFH > 1y), (iii) not hospitalized using loop diuretics (NoHFH/LD+), and (iv) not hospitalized without loop diuretics (NoHFH/LD−). Between-group associations, all-cause mortality (ACM), and cardiology follow-up were analysed using survival models. Results: The study included 655 919 patients [80 years (70–87), 48% female]. One-year ACM risk was 15.9%, ranging from 8.0% (NoHFH/LD−) to 25.0% (HFH ≤ 1y). Mortality risk was 1.61-fold higher for NoHFH/LD+, 1.83-fold for HFH > 1y, and 2.32-fold for HFH ≤ 1y compared to NoHFH/LD− (P < .0001). During the first year of follow-up (2020), cardiology consultation rates were similar across groups, with 40% of patients lacking an annual visit. Compared to no consultation, a single cardiology visit in the previous year (2019) was associated with a 6%–9% absolute reduction in 1-year ACM during the following year (2020) across all groups. The number needed to consult (NNC) to prevent one modelled death was 11–16. Additional visits showed greater benefit with increasing HF severity, with NNC ranging from 55 (NoHFH/LD−) to 20 (HFH ≤ 1y). The optimal follow-up to minimize the number of deaths without increasing the total number of consultations was 1 annual visit for NoHFH/LD−, 2–3 visits for NoHFH/LD+ and HFH > 1y, and 4 visits for HFH ≤ 1y patients. Conclusions: Despite having a HF diagnosis, 40% of patients do not see a cardiologist annually, regardless of disease severity. Simple stratification based on hospitalization history and diuretic use effectively predicts outcomes. Tailoring the annual number of HF consultations according to this stratification could optimize resource use and reduce avoidable modelled deaths.

Aims: Patients who experience hospitalizations due to heart failure (HF) face a significant risk of readmission and mortality. Our objective was to evaluate whether the risk of hospitalization and mortality following discharge from HF hospitalization differed based on adherence to the outpatient follow-up (FU) protocol comprising an appointment with a general practitioner (GP) within 15 days, a cardiologist within 2 months or both (termed combined FU). Methods and results: We studied all adults admitted for a first HF hospitalization from 2016 to 2020 in France's Grand Est region. Association between adherence to outpatient FU and outcomes were assessed with time-dependent survival analysis model. Among 67 476 admitted patients (mean age 80.3 ± 11.3 years, 53% women), 62 156 patients (92.2%) were discharged alive and followed for 723 (317–1276) days. Combined FU within 2 months was used in 21.1% of patients, with lower rates among >85 years, women, and those with higher comorbidity levels (p < 0.0001 for all). Combined FU was associated with a lower 1-year death or rehospitalization (adjusted hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.88–0.94, p < 0.0001) mostly related to lower mortality (adjusted HR 0.65, 95% CI 0.62–0.68, p < 0.0001) whereas HF readmission was higher (adjusted HR 1.19, 95% CI 1.15–1.24, p < 0.0001). When analysing components of combined FU separately, 1-year mortality was more related to cardiologist FU (HR 0.65, 95% CI 0.62–0.67, p < 0.0001), than GP FU (HR 0.87, 95% CI 0.85–0.90, p < 0.0001). Conclusion: Combined FU is carried out in a minority of patients following HF hospitalization, yet it is linked to a substantial reduction in 1-year mortality, albeit at the expense of an increase in HF hospitalizations.

Aims: The prognostic value of ‘high dose’ loop diuretics in advanced heart failure outpatients is unclear. We aimed to assess the prognosis associated with loop diuretic dose in ambulatory patients awaiting heart transplantation (HT). Methods and results: All ambulatory patients (n = 700, median age 55 years and 70% men) registered on the French national HT waiting list between 1 January 2013 and 31 December 2019 were included. Patients were divided into ‘low dose’, ‘intermediate dose’, and ‘high dose’ loop diuretics corresponding to furosemide equivalent doses of ≤40, 40–250, and >250 mg, respectively. The primary outcome was a combined criterion of waitlist death and urgent HT. N-terminal pro-B-type natriuretic peptide, creatinine levels, pulmonary capillary wedge pressure, and pulmonary pressures gradually increased with higher diuretic dose. At 12 months, the risk of waitlist death/urgent HT was 7.4%, 19.2%, and 25.6% (P = 0.001) for ‘low dose’, ‘intermediate dose’, and ‘high dose’ patients, respectively. When adjusting for confounders, including natriuretic peptides, hepatic, and renal function, the ‘high dose’ group was associated with increased waitlist mortality or urgent HT [adjusted hazard ratio (HR) 2.23, 1.33 to 3.73; P = 0.002] and a six-fold higher risk of waitlist death (adjusted HR 6.18, 2.16 to 17.72; P < 0.001) when compared with the ‘low dose’ group. ‘Intermediate doses’ were not significantly associated with these two outcomes in adjusted models (P > 0.05). Conclusions: A ‘high dose’ of loop diuretics is strongly associated with residual congestion and is a predictor of outcome in patients awaiting HT despite adjustment for classical cardiorenal risk factors. This routine variable may be helpful for risk stratification of pre-HT patients.