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Introduction of a multidisciplinary specialist heart failure team prevented 2 in 3 heart failure readmissions

Session Poster Session 4

Speaker Carla Plymen

Event : Heart Failure 2019

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

Authors : S Hadjiphilippou (London,GB), G Cole (London,GB), C Plymen (London,GB)

Authors:
S Hadjiphilippou1 , G Cole1 , C Plymen1 , 1Imperial College Healthcare NHS Trust - London - United Kingdom of Great Britain & Northern Ireland ,

Citation:

Background and objectives: 

Over half a million people are living in the UK with heart failure (HF), costing 2% of the National Health Service budget, of which 60-70% is incurred from hospitalisation. Management of patients within a dedicated HF unit improves mortality and reduces readmission rates. Our objective was to assess HF length of stay and readmission rates for patients admitted to a dedicated HF unit when compared to standard medical care within a tertiary centre.

Methods: 

Patients admitted with HF over a single year (2015-16) at a multicentre tertiary NHS Trust were included in this retrospective cohort study.  Heart failure length of stay and readmission rates (within 30 days) for patients admitted under the direct care of an inpatient specialist heart failure service were compared to HF admissions under a general medical team.

Results: 

A total of 479 patients were admitted with HF over 12 months.  Of these, 32% were to a dedicated HF unit. Mean age of those admitted to the unit was 69.4yrs compared to 77yrs when admitted under the general medical team (p<0.05). There was no significant difference in initial length of stay between those admitted under the specialist HF team and those under the general medical team during the initial admission. However, incidence of readmission was significantly less when the index admission was under the specialist HF team (6.5% vs 17.5%, p<0.05). Patients readmitted under the care of a specialist HF team had a numerically shorter length of stay than those admitted under the general medical team (6.3 Vs 9 days respectively). 

Conclusion: 

Direct admission under a HF specialist team prevented 2 in 3 readmissions at 30 days and reduced by 1/3 the length of stay during readmissions.  Reasons postulated are earlier pharmacological intervention, faster medication up-titration, discharge on optimal doses, more intensive diuresis during admission and access to advice and guidance to avoid admission. Using an average HF admission cost of £3796, expansion of our service would be expected to save ˜£136656 over one year because of ˜36 fewer readmissions.  In addition to the improvement in morbidity and mortality in patients with HF, our results suggest significant financial gains could be made from ensuring patients are admitted under a HF specialist team.

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