S Nicholls*,  K Inder, J Lowe, B Bastian, P Candlish, J Holliday and D O'Connell.

John Hunter Hospital, Newcastle.

Background: Heart failure clinics optimise medical therapy and focus on lifestyle modifications and exercise. The aim of the study was to compare the outcome of patients participating in the clinic with those who refused or were excluded and a cohort of patients admitted with heart failure in 1993.

Method:  183 patients were admitted over a 5 month period in 1998 with heart failure.  Patients were invited to attend a clinic on discharge involving a home visit, 3 outpatients visits, rehabilitation sessions and an optional exercise programme.  Clinical data and outcome were recorded.

Results: 59 patients participated in the clinic.  50 refused and 74 were excluded.  54% of patients in the clinic group were male and mean age in the clinic group was 71 years (46-98).  Patients who refused or were excluded were more likely to be female (64%) and were older with a mean age 79 years (60-95).  In comparison to the 1993 cohort, clinic patients were more likely to receive an ACE inhibitor an angiotensin II blocker (93% v 66%), beta blocker (30% v 6%), diuretics (97% v 71%) and digoxin (63% v 45%).  Aspirin (67% v 37%) and warfarin (17% v 10%) use was also greater in the clinic group.  Clinic patients were less likely to receive calcium antagonists (10% v 24%).  28 day unplanned admission and mortality at 28 days and 12 months are listed in the following table.

Conclusion: An increase in appropriate therapy for patients with heart failure resulted in improved unplanned readmission with little change in mortality.  Whilst the group who attended the clinic appeared to benefit in terms of reduced mortality and unplanned hospital readmissions, the results may suggest that those patients who are too unwell to take part have a worse outcome.

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