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OPTIMIZE Heart Failure Care Program in Mexico. Impact on early and mid term Heart Failure readmissions

Session Poster Session 4

Speaker Jose Antonio Magana Serrano

Event : Heart Failure 2019

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

Authors : JA Magana-Serrano (mexico city,MX), JA Cigarroa-Lopez (mexico city,MX), R Cantero-Colin (mexico city,MX), G Maza-Juarez (mexico city,MX), H Galvan-Oseguera (mexico city,MX), LE Santos-Martinez (mexico city,MX), MA Alcocer-Gamba (Queretaro,MX)

Authors:
JA Magana-Serrano1 , JA Cigarroa-Lopez1 , R Cantero-Colin1 , G Maza-Juarez1 , H Galvan-Oseguera1 , LE Santos-Martinez1 , MA Alcocer-Gamba2 , 1cardiology hospital. National Medical Centre "Siglo XXI", IMSS, Division of Heart Failure and Cardiac Transplantation - mexico city - Mexico , 2Instituto del Corazon de Queretaro - Queretaro - Mexico ,

On behalf: OPTIMIZE HEART FAILURE CARE PROGRAM

Citation:

Introduction. Acute Heart Failure (AHF) is a frequent clinical condition that is related to adverse outcomes. The OPTIMIZE Heart Failure Care program focuses on the early optimization of the integral treatment of heart failure after hospitalization for AHF and during the vulnerable phase. It consider three steps: 1. Start and/or optimization of treatment before discharge, 2. Use of a check-list in the pre-discharge period as a safety barrier and 3. Patient education and follow-up.

Methods: We implement the OPTIMIZE HF program in a prospective cohort of hospitalized AHF patients without inotropic requirements. Optimized treatment was defined as the proper use of drugs recommended by current clinical practice guidelines (ACEIs/BRAs, Beta blockers, Aldosterone antagonists, Ivabradine and diuretics), use of CRT and/or ICDs in selected patients and HF education for patients, relatives and caregivers. The primary outcomes were the frequency of HF re-admissions at 30, 90 and 180 days. The results were compared with a historical cohort of 167 patients with the same characteristics.

Results: 165 patients with AHF were studied prospectively. The average age was 58+/-4 years in the prospective group and 60+/-3 years in the comparative group (p = NS), the leading HF etiology  in both groups was ischemic heart disease, the mean LVEF was 29+/-5% in the prospective group and 31+/-6 % in the historical cohort (p=NS). The proportion of patients with optimized treatment was 91% in the prospective group and 63% in the comparator (p <0.05). The impact of the early optimization protocol showed a significant reduction in the readmission rate 12% vs 29 % at 30 days, 8% vs. 20% at 90 days and 4% vs. 15% at 6 months (p<0.05 in all comparisons) (Table I).

Conclusions: In this population, the OPTIMIZE HF program was effective in reducing re-admissions in the short and mid-term after an episode of AHF. It can be considered as a true window of opportunity for a group of patients during the vulnerable phase.

OPTIMIZE HF Care Program (n=165)

Historical cohort (n=167)

P- value

Age (years)

58+/-4

60+/-3

NS

Ischemic heart disease as primary HF etiology (%)

55

53

NS

LVEF (%)

29+/-5

31+/-6

NS

Readmission rate

30 day

90 days

180 days

12

8

4

29

20

15

< 0.05

< 0.05

<0.05

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