IMPROVED OUTCOMES FROM A COMPREHENSIVE MANAGEMENT SYSTEM
FOR HEART FAILURE. D. Holst*, D. Kaye, M. Richardson, H.
Krum, D. Prior, A. Aggarwal, R. Wolfe, 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. We assessed the
ability of a comprehensive management programme (CMP) for CHF to reduce
admissions with secondary endpoints of improving quality of life (QOL) and
exercise capacity. Eligible patients were NYHA Class 3 or 4
CHF, LVEF <40% and stable outpatient therapy. CMP comprised cardiology assessment and follow up, intensive
education and referral to a tailored exercise programme. A dedicated practice nurse coordinated
CMP. Hospitalisations were compared in
the 6 months pre and post enrollment.
Other data were analysed at baseline and 6 month follow up 42 pts (35M, 7F,
mean age 54yrs) were enrolled. Two pts
were transplanted, 2 died during follow up and 2 pts failed to return for
follow up. 36pts completed the study. Hospital admissions were dramatically
reduced by 87.2% and bed days by 92%.
Exercise capacity, QOL and targeted drug dosing improved significantly. Baseline 6
mths follow‑up P Admissions/pt* 1.05±0.16 0.08±0.04 0.0001 Total
bed days (d)* 7.68±1.45 0.27±0.18 0.0001 NYHA
Class 3.1±0.05 1.8±0.13 0.0001 QOL
(Total score)# 54±3.7 33±4.4 0.0001 6
minute walk (m) 413±21.1 496±17.6 0.0002 ACEI
Dose increase 42% 0.0008 Beta
Blocker Dose increase 61% 0.00001 * 6 months pre-enrolment vs. 6 months post enrolment # Minnesota Living with Heart Failure
Questionnaire Conclusion: A comprehensive heart failure management programme improves QOL
and exercise capacity as well as substantially reducing hospital
admissions. This study validates the
need for intensive outpatient care of CHF and should translate into
significantly reduced health care costs.
Mean
± SE
Mean
± SE
