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Reassuring community heart failure care in the absence of specialist involvement; but some gaps indicate need for continued specialist team input

Session Poster Session 4

Speaker Rebabonye Pharithi

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Multidisciplinary Interventions
  • Session type : Poster Session

Authors : R B Pharithi (Dublin,IE), M Ferre-Vallverdu (Dublin,IE), C Walsh (Dublin,IE), L Fennell (Dublin,IE), J Gallagher (Dublin,IE), R Fawsitt (Dublin,IE), M Ledwidge (Dublin,IE), K Mcdonald (Dublin,IE)

Authors:
R B Pharithi1 , M Ferre-Vallverdu1 , C Walsh1 , L Fennell1 , J Gallagher1 , R Fawsitt1 , M Ledwidge1 , K Mcdonald1 , 1St Vincent's University Hospital, Heart Failure Unit - Dublin - Ireland ,

Citation:

Introduction:
Adherence to guideline-recommended therapy in heart failure (HF) management among patients receiving cardiology care remains a concern. Given that the majority of HF patients do not receive regular specialist input, this concern is likely heightened in patients exclusively managed in the primary care setting. Aim of this study was to evaluate the community care gaps in HF population who are not under active cardiology management.
Methods and study setting:
Irish Data from 15 family practitioner services have been interrogated. Patients with confirmed HF diagnoses and no contact with secondary care services for =1 year were assessed. Quality of care for HF-PEF patient was based on 5 items: self-care education,  flu vaccination, clinic BP control <140/ 90mmHg, appropriate use of oral anticoagulants and avoidance of inappropriate medicines (1 point per item if strategy adhered to; max score 5). For HF-REF (LVEF<45%) in addition to above metrics a point was given for use of ACEi/ARB/ARNi, Beta-blocker and/or MRA, and Appropriate device therapy (HF-REF; Total Score 9).
Results: 
220 patients (77±9 years; 56% male) included. 70% were documented HF- PEF phenotype and mean care score was 3.76 ± 0.55. The most obvious gap in management was self-care education provided(in = 2% of patients); Other management strategies were achieved in > 85% of patients. In the HF-REF cohort, the mean score was 6.51 ± 1.23 with self-care again being poor (22.6%). In addition, there was a deficit in MRA prescription (21% of patients); whereas  >80% had ACEi/ARB/ARNi and BB. 66% had Appropriate device therapy. Target doses achieved; 66% for ACEi/ARB/ARNi, 88% for BB and 92% for MRA.
Conclusions: 
Data from a HF population exclusively managed in primary care demonstrated an overall acceptable standard of management. Failure to educate patients/family in self-care strategies is a prevalent gap across both phenotypes. Notable under-utilisation of MRA among HF-REF patients might reflect the lack of awareness of the value of the intervention. This last observation underscores the need for continuing contact between primary and secondary care teams to ensure heart failure care management reflects current guidelines.

Total (n=220)

HF-PEF (n=155)

HF-REF (n=62)

p-value

Self-care education

17 (7.7%)

3 (1.9%)

14 (22.6%)

<0.001

BP control

190 (86.8%)

132 (85.2%)

56 (91.8%)

ns

Flu vaccination

209 (95.4%)

150 (96.8%)

56 (91.8%)

ns

Appropiate use OAC

210 (95.9%)

149 (96.1%)

58 (95.1%)

ns

Use of inappropiate medicines

10 (4.6%)

6 (3.9%)

4 (6.6%)

ns

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