The Effect of an Organized Heart Failure Program on the Rate and Time to First Readmission in Patients Discharged with a Diagnosis of Acute Decompensated Heart Failure Admitted to Cardiology Department, Ayub Teaching Hospital, Abbottabad.
Abstract
Background: Heart Failure (HF) is globally recognized as one of the major causes of morbidity and mortality as it has severe lasting impacts on quality of life, healthcare finances, and survival. Keeping in view the poor prognosis associated with ADHF admissions, structured heart failure programs can enhance treatment adherence, foster better self-care, and lower the rate of readmissions. This study was carried out to evaluate the impact of a structured heart failure program on the readmission rates and clinical outcomes of patients with acute decompensated heart failure at Ayub Teaching Hospital, Abbottabad. Methods: 30 patients were recruited in this longitudinal study as per the inclusion criteria; aged between 20 to 80 years, within 7 days of their discharge, and followed for 20 weeks in a specialized heart failure clinic, with regular follow-ups, guideline-directed medical therapy (GDMT) optimization and patient education. Results: Out of the 30 patients enrolled (mean age 65.26 years; 53% male) with a history of 2 prior admissions for acute decompensated heart failure (ADHF) in the last 6 months, 24 completed the program. GDMT adherence improved significantly, with beta-blocker usage reaching 100%. The unscheduled readmission (defined as unscheduled visit for worsening heart failure resulting in admission) for worsening heart failure or all cause death rate was 13%.There were no deaths recorded due to worsening heart failure. NT-proBNP levels declined notably, and ejection fraction improved or remained stable for most of the patients. Approximately 23% of the patients were classified as NYHA class I at baseline, which improved to 67% at the final visit. Conclusion: This pilot study demonstrated that a structured heart failure program improved clinical outcomes in terms of unscheduled admissions or deaths due to worsening heart failure underscoring the need for establishing specialized multidisciplinary heart failure clinics.
Keywords: Heart Failure program; Acute Decompensated Heart failure; GDMT
References
1. Cheema H Khan, M, Shahid A, Nawaz A, Ilyas A, Athar F, et al. Trends in the burden of heart failure in Pakistan, 1990-2029: An Analysis of the global burden of disease study 2019. J Am Coll Cardiol 2024;83(13_Suppl)720.
2. Mebazaa A, Yilmaz MB, Lev P, Ponikowski P, Peacock WF, Laribi S, et al. Recommendations On Pre-Hospital And Early Hospital Management Of Acute Heart Failure: A Consensus Paper From The Heart Failure Association Of The European Society Of Cardiology, The European Society Of Emergency Medicine And The Society Of Academic Emergency Medicine – Short Version. Eur Heart J 2015;36(30):1958–66.
3. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M, et al. The global health and economic burden of hospitalizations for heart failure. J Am Coll Cardiol 2014;63(12):1123–33.
4. Crespo-Leiro MG, Anker SD, Maggioni AP, Coats AJ, Filippatos G, Ruschitzka F, et al. European Society of Cardiology Heart Failure long-term registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions. Eur J Heart Fail 2016;18(6):613–25.
5. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022;145(18):e895–1032.
6. Al-Omary MS, Khan AA, Davies AJ, Fletcher PJ, Mcivor D, Bastian B, et al. Outcomes following heartfailure hospitalization in a regionalAustralian setting between 2005 and2014.ESC heart failure2018;5:271–278
7. McAlister FA, Stewart S, Ferrua S, McMurray JJ. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol 2004;44(4):810–9.
8. Wideqvist M, Cui X, Magnusson C, Schaufelberger M, Fu M. Hospital readmissions of patients with heart failure from real world: timing and associated risk factors. ESC Heart Fail 2021;8(2):1388–97.
9. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2021;42(48):3599–726.
10. Fonarow GC, Stevenson LW, Walden JA, Livingston NA, Steimle AE, Hamilton MA, et al. Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure. J Am Coll Cardiol 1997;30(3):725–32.
11. Inglis SC, Clark RA, McAlister FA, Ball J, Lewinter C, Cullington D, et al. Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database Syst Rev 2010;4(8):CD007228.
12. Muk B, Bánfi-Bacsárdi F, Vámos M, Pilecky D, Majoros Z, Török GM, et al. The Impact of Specialised Heart Failure Outpatient Care on the Long-Term Application of Guideline-Directed Medical Therapy and on Prognosis in Heart Failure with Reduced Ejection Fraction. Diagnostics (Basel) 2024;14(2):131.
13. Pant BP, Satheesh S, Pillai AA, Anantharaj A, Ramamoorthy L, Selvaraj R. Outcomes with heart failure management in a multidisciplinary clinic - A randomized controlled trial. Indian Heart J 2022;74(4):327–31.
14. McDonald K, Ledwidge M, Cahill J, Quigley P, Maurer B, Travers B, et al. Heart Failure Management: Multidisciplinary Care Has Intrinsic Benefit above the Optimization of Medical Care. J Card Fail 2002;8(3):142–8.
15. Koser KD, Ball LS, Homa JK, Mehta V. An Outpatient Heart Failure Clinic Reduces 30-Day Readmission and Mortality Rates for Discharged Patients: Process and Preliminary Outcomes. J Nurs Res 2018;26(6):393–8.
16. Mebazaa A, Davison B, Chioncel O, Cohen-Solal A, Diaz R, Filippatos G, et al. Safety, Tolerability and Efficacy of Up-titration of Guideline-Directed Medical Therapies for Acute Heart Failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet. 2022;400:1938–1952.
17. Greene SJ, Butler J, Albert NM, DeVore AD, Sharma PP, Duffy CI, et al. Medical Therapy for Heart Failure With Reduced Ejection Fraction The CHAMP-HF Registry. J Am Coll Cardiol 2018;72(4):351–66.
18. Rudolf Berger MD, DeddoMoertl MD, Seiglinde Peter RN, RoozbehAhmedi MD, Martin Huelsmann MD, Susan Yamuti RN, et al. N-Terminal Pro-B-Type Natriuretic Peptide-Guided, intensive patient management in addition to multidisciplinary care in chronic heart failure: A 3-arm, prospective randomized pilot study. J Am Coll Cardiol 2010;55(7):645–53.
19. Anand IS, Fisher LD, Chiang YT, Latini R, Masson S, Maggioni AP, et al. Val-HeFT Investigators. Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT). Circulation 2003;107(9):1278–83.
20. Collins SP, Pang PS, Fonarow GC, Yancy CW, Bonow RO, Gheorghiade M. Is hospital admission for heart failure really necessary? The role of emergency department and observation unit in preventing hospitalization and rehospitalization. J Am Coll Cardiol 2013;61(2):121–6.
21. Gupta A, Allen LA, Bhatt DL, Cox m, DeVore AD, Heidenreich PA, et al. Association of heart failure readmissions reduction program implementation with readmission and mortality outcomes in heart failure. JAMA Cardiolo 2018;3(1):44–53.
22. Baudry G, Pereira O, Duarte K, Ferreira JP, Savarese G, Welter A, et al. Risk of readmission and death after hospitalization for worsening heart failure: Role of post-discharge follow-up visits in a real world study from the Grand Est Region of France. Eur J Heart Fail 2004;26(2):342–56.
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Saad Shams, Muhammad IMRAN KHAN, Fatima Javed, Rakhshanda Afsar, Zia Ullah Khan, Aftab Ahmad, Mati Ullah Khan
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
