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Structured follow-up program of patients with heart failure: impact on quality of life and prognosis.

Session Patient management - From oral treatment to transplant

Speaker Joao AGOSTINHO

Congress : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Multidisciplinary Interventions
  • Session type : Rapid Fire Abstracts
  • FP Number : 1536

Authors : JPR Agostinho (Lisbon,PT), J Rigueira (Lisbon,PT), A Nunes-Ferreira (Lisbon,PT), R Santos (Lisbon,PT), I Aguiar-Ricardo (Lisbon,PT), I Goncalves (Lisbon,PT), T Guimaraes (Lisbon,PT), R Pires (Coimbra,PT), F Veiga (Lisbon,PT), M Mendes Pedro (Lisbon,PT), FJ Pinto (Lisbon,PT), D Brito (Lisbon,PT)

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Authors:
JPR Agostinho1 , J Rigueira1 , A Nunes-Ferreira1 , R Santos1 , I Aguiar-Ricardo1 , I Goncalves1 , T Guimaraes1 , R Pires2 , F Veiga1 , M Mendes Pedro1 , FJ Pinto1 , D Brito1 , 1Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon University - Lisbon - Portugal , 2Faculty of Psychology, CINEICC, University of Coimbra - Coimbra - Portugal ,

On behalf: RICA-HFTeam

Citation:

Introduction: Patients with heart failure (HF) benefit from regular clinical follow-up in order to maintain therapeutic optimization and to identify early signs of decompensation, thereby reducing readmission rates and improving prognosis. However, the magnitude of this potential benefit is seldom objectified.

Objective: To evaluate the actual impact of the implementation of a structured follow-up program in pts with HF, regarding quality of life (QoL) and hospitalization and mortality rates.

Methods: Nested-case control study, with prospective data registry of 50 consecutive pts discharged after hospitalization for acute HF (AHF). This population (study group) was followed (HF team) at 10 days, 3, 6 and 12 months after discharge, with predefined procedures (by protocol), including clinical evaluation, therapeutic optimization (according to ESC guidelines), laboratorial, electrocardiographic and echocardiographic evaluations, and QoL assessment [Kansas City Cardiomyopathy Questionnaire (KCCQ)]. The control group consisted of 100 pts hospitalized for AHF and regularly followed after discharged but prior to the implementation of the protocol. Cox Regression, Kaplan-Meier survival analysis and Wilcoxon test were the statistical methods used.

Results: The study group (mean age: 67.1±11 years, 75.5% males) had a mean left ventricular ejection fraction (LVEF) of 27.6±10.3% (85.7% with LVEF<40%) at discharge. Sixteen pts (31%) were discharged in NYHA I functional class, 63.3% in class II and 6.1% in class III. Demographics and all functional cardiac variables were similar in the two. Mean follow-up time was 8.2±5.3 months in the study group, and 8±4.7 months in the control group (p=NS).

In the study group, there was a significant improvement in LVEF (p<0.001), NYHA functional class (p=0.001), and in all the parameters assessed by the KCCQ, namely in symptoms (p<0.001) and overall QoL (p<0.001). There was also an effective optimization of treatment during follow up, including the up-titration of recommended drugs: compared to the doses of pharmacological therapies previously used before the index-admission for AHF, a significant increase in doses of angiotensin converting enzyme inhibitor/angiotensin II receptor antagonists (p<0.001), beta-blockers (p<0.001) and mineralocorticoids receptor antagonists (p<0.001), was achieved during follow up.

In comparison with the results observed in the control group, the group included in the structured follow-up program showed a significant reduction in all cause readmissions (24.5% vs 61.2%, p=0.001), HF readmissions (16.3% vs 36.7%, p=0.001) and total mortality (2% vs 18.4%, p=0.001) during follow up. Conclusion: A structured follow-up program of HF patients allowed a significant reduction in readmission and mortality rates in the medium term, and was associated with a significant improvement in functional class, quality of life, and LVEF. These results support the imperative need to establish such programs.

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