IMPROVED OUTCOMES FROM A COMPREHENSIVE MANAGEMENT SYSTEM FOR HEART FAILURE
D. Holst*, D. Kaye, M. Richardson, H. Krum, D. Prior, P. Bergin.
Heart Failure Centre (HFC), the Alfred Hospital, Melbourne, Victoria.
Background: Congestive heart failure (CHF) is associated with a high readmission rate after diagnosis. Poor patient (pt) compliance and lack of awareness of warning signs are common causes of readmission. Reduced inpatient care (IPC) can substantially decrease the economic burden of CHF.
Aim: To assess the ability of a comprehensive management programme (CMP) for CHF to reduce IPC with secondary endpoints of improving quality of life (QOL) and exercise capacity.
Methods: Pts with NYHA Class 3 or 4 CHF, LVEF <40% and stable medical therapy were eligible. CMP comprised outpatient assessment and follow-up by an NFC cardiologist, intensive pt education and referral to a tailored CHF exercise programme. A dedicated practice nurse co-ordinated CMP. Duration of IPC was compared in the 6 months pre and post-enrolment. Other data were analysed at baseline and 6 month follow-up.
Results: 32 patients were enrolled in the study. Two pts were transplanted, 2 died prior and 14 pts (12M: 2F, mean age 55.9 yrs, mean LVEF 19%) have completed 6 month follow-up. Only 2 pts were hospitalised after enrolment. IPC was dramatically reduced and QOL improved significantly.
|
Baseline Mean±SE |
6 mths follow-up Mean±SE |
P |
|
|
Admissions/pt* |
1.07±SE |
0.14±0.01 |
0.006 |
|
Total bed days (d)* |
8.71±2.6 |
0.57±0.4 |
0.005 |
|
NYHA Class |
3.14±0.01 |
2.0±0.2 |
0.006 |
|
QOL (total score)# |
56.3 |
37.5 |
0.008 |
|
6 minute walk (m) |
447±21.6 |
487±30.4 |
0.07 |
*6 months pre-enrolment vs 6 months post-enrolment
#Minnesota Living with Heart Failure Questionnaire
Conclusion: A comprehensive heart failure management programme substantially reduces IPC in CHF whilst providing an improvement in QOL. This study validates the need for intensive outpatient care of CHF and should translate into significantly reduced health care costs.
