1University of Manchester - Manchester - United Kingdom of Great Britain & Northern Ireland
2Liverpool Heart and Chest Hospital - Liverpool - United Kingdom of Great Britain & Northern Ireland
Heart failure (HF) epidemic is estimated to affect 26 million people worldwide, with nearly a million patients living in the United Kingdom alone. Guideline directed medical therapy improves survival and quality of life in HF patients. Long-term adherence with medical therapy declines after discharge from hospital and under-treatment with evidence-based pharmacotherapy is an important problem in community dwelling HF patients.
This observational study aims to assess the impact of a cardiologist led community HF service (comprising consultant, HF specialist nurses and allied health professionals) on the delivery of / adherence to first line treatments for HF patients, their unplanned hospital admission / readmission rates and length of stay.
Retrospective data analysis of 700 consecutive patients treated by our community heart failure service was included in this study. Data were collected from medical records, prescriptions, hospital episode statistics (HES) database and national audit office socio-economic database for the north-west of England.
Baseline study characteristics: Mean Age (79 years +/- 8), Gender (Male =65%, Female=35%), ECG rhythm (Sinus Rhythm=65% , AF=35%), NYHA class (I -10%, II &III -88% , IV – 2%), Aetiology of HF (IHD 52%, Idiopathic cardiomyopathy 16%, Valve disease 12%, Hypertension 10%, Other 20%), Heart Rate (<80/minute -85%) and Blood Pressure (135/80 mmHg – 66%).
Of the study cohort, 85% were taking first line HF treatment as recommended by the NICE UK guidelines (beta blocker 85%, ACE inhibitors 65%, MRA 65%). This is well above the regional average (60%). Of the patients taking beta-blockers, most were on cardio-selective drugs (Bisoprolol, Nebivolol ,Carvedilol); and >50% were on the target dose. Clear explanations were documented in medical records for the patients not on a first line drug or below target dose.
For the study period (2017); HF related unplanned hospital admission rate for our local community was 310 (per 100,000 population) and re-admission rates 38 (per 100,000 population) were much lower than the northwest average 600 and 72.5 per 100,000 population, respectively. Average Length of stay for HF related hospital admission in the study population was 5.07 days (compared to regional average of 9 days).
Our study shows that a consultant-led community HF service significantly improves delivery of guideline directed therapy by offering expertise and skill-set required to maintain patients on appropriate dosages of first line medications required to achieve target heart rate and blood pressure; and as a result lower admission and re-admission rates. Large scale studies and national audits must include community dwelling HF patients to get a better snapshot of how this increasingly complex medical problem is managed in the real world after hospital discharge.