Authors (including presenting author) :
Ho KH (1), Mow HC (1), IP NS (2), Cheung C (1), Yeung GWM (2), Chu PLM (2), Yam PW (1)
Affiliation :
(1) Department of Medicine and Geriatrics, Tuen Mun Hospital
(2) Department of Pharmacy, Tuen Mun Hospital
Introduction :
Heart failure (HF) is a debilitating disease with high mortality and readmission rate, it also imposes negative impact on patients’ quality of life (QOL). Underutilization of guideline-directed medical therapy (GDMT), lengthy follow-up period and lack of self-care education are main gaps in heart failure managements. Therefore, we set up a Multidisciplinary Heart Failure Clinic in 2020, aiming to bridge these gaps.
Objectives :
To evaluate the impact of Multidisciplinary HF Clinic on readmission rate at 30 days and 6 months, utilization of GDMT, left ventricular ejection fraction (LVEF), 6-minute walk distance and QOL.
Methodology :
Patients who were hospitalised for HF and had LVEF ≤ 40% were recruited. Patients with other major organ comorbidities were excluded. Prior to discharge for HF, nurse and pharmacist would provide education on self-managements and medications. Early review was arranged during the vulnerable post-discharge period. Multidisciplinary HF Clinic consisted of 3 main elements: cardiologist consultation, nurse education and pharmacist-led medication titration. Patients would be regularly followed-up every 4 weeks for symptoms review and medication titration. They would be discharged from clinic after medications reached maximal tolerated dose.
Result & Outcome :
From 10/2020 to 8/2022, 128 patients had their medications maximally titrated. When compared to historical matched cohort, readmission rate within 30 days was significantly reduced from 21% to 4.7% (p< 0.001). Readmission rate within 6 months was also significantly reduced from 32.5% to 7.8% (p< 0.001). For the utilization of GDMT, 18 (14.1%), were on dual therapy, 44 (34.4%) were on triple therapy, and 66 (51.5%) were on quadruple therapy upon program discharge, whereas only 34.9% and 6.9% of patients were on triple and quadruple therapy in the historical cohort respectively.
There was significant improvement of LVEF from 26% to 45% (p< 0.001). 6-minute walk distance improved from 355m to 440m (p< 0.05) and Kansas City Cardiomyopathy Questionnaire (KCCQ) score improved from 69 to 88 (p< 0.05). These signified a favourable impact on patients’ QOL .
In conclusion, Multidisciplinary HF clinic that emphasised on pre-discharge education, early post-discharge review, frequent follow-up for GDMT titration has significantly reduced readmissions, improved use of GDMT, and led to better LVEF, functional status and quality of life.
