121 A 5-year single-centre experience of managing patients with cardiorenal syndrome in the multi-disciplinary cardiorenal clinic

Joshi, Mithilesh; Tran, Patrick; Kuehl, Michael; Ayub, Waqar; Hamer, Rizwan; Khweir, Laith; Banerjee, Prithwish

doi:10.1136/heartjnl-2022-bcs.121

Cited by 1 publication

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“…From our experience, some of these patients may be better served in a joint cardio-renal clinic, which we also run alongside the HFpEF clinic. 10 …”

Section: Discussionmentioning

confidence: 99%

“…The study also highlighted the poor prognosis associated with low eGFR but did not suggest how these patients should be specifically managed in clinic. From our experience, some of these patients may be better served in a joint cardio-renal clinic, which we also run alongside the HFpEF clinic 10…”

Section: Discussionmentioning

confidence: 99%

“…In principle, the ageing phenotype may guide strategies for reducing vascular stiffness 7 ; an obesity phenotype may permit the use of glucagon-like peptide-1 receptor agonists (GLP1-RA) by weight management specialists, 8 while a renal dysfunction phenotype may prompt ultrafiltration or SGLT2i for renal protection regardless of HF. [9][10][11] In practice, the marked overlap between groups makes this approach difficult. 12 With the array of diagnostic intricacies, novel therapies and firmer recommendations to optimise non-cardiac comorbidities, 12 13 it is uncertain if our current clinic model can adequately deliver this to the HFpEF population.…”

Section: How This Study Might Affect Research Practice or Policymentioning

confidence: 99%

“… 16 While the concept of joint clinics seems appealing, it is unlikely to serve as a practical solution within the finite resources of the National Health Service (NHS). Based on our experiences in running a multispecialty cardiorenal clinic, 10 which serves a smaller patient group, the financial costs and shortage of specialists make it difficult to translate this model to the sheer population size of HFpEF. 2 3 Instead, outpatient HF pathways should be redesigned into a more efficient system.…”

Section: Introductionmentioning

confidence: 99%

“…One individualised approach is to target specific therapies to specific phenotypes, but this also has its limitations. In principle, the ageing phenotype may guide strategies for reducing vascular stiffness7; an obesity phenotype may permit the use of glucagon-like peptide-1 receptor agonists (GLP1-RA) by weight management specialists,8 while a renal dysfunction phenotype may prompt ultrafiltration or SGLT2i for renal protection regardless of HF 9–11. In practice, the marked overlap between groups makes this approach difficult 12.…”

Section: Introductionmentioning

confidence: 99%

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Developing a contemporary community clinic for patients with heart failure with preserved ejection fraction within the current National Health Service model

et al. 2022

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IntroductionThe diagnostic and therapeutic arsenal for heart failure with preserved ejection (HFpEF) has expanded. With novel therapies (eg, sodium-glucose co-transporter 2 inhibitors) and firmer recommendations to optimise non-cardiac comorbidities, it is unclear if outpatient HFpEF models can adequately deliver this. We; therefore, evaluated the efficacy of an existing dedicated HFpEF clinic to find innovative ways to design a more comprehensive model tailored to the modern era of HFpEF.MethodsA single-centre retrospective analysis of 202 HFpEF outpatients was performed over 12 months before the COVID-19 pandemic. Baseline characteristics, clinic activities (eg, medication changes, lifestyle modifications, management of comorbidities) and follow-up arrangements were compared between a HFpEF and general cardiology clinic to assess their impact on mortality and morbidity at 6 and 12 months.ResultsBetween the two clinic groups, the sample population was evenly matched with a typical HFpEF profile (mean age 79±9.6 years, 55% female and a high prevalence of cardiometabolic comorbidities). While follow-up practices were similar, the HFpEF clinic delivered significantly more interventions on lifestyle changes, blood pressure and heart rate control (p<0.0001) compared with the general clinic. Despite this, no significant differences in all-cause hospitalisation and mortality were observed. This may be attributed to the fact that clinic activities were primarily cardiology-focused. Importantly, non-cardiovascular admissions accounted for >60% of hospitalisation, including causes of recurrent admissions.ConclusionThis study suggests that existing general and emerging dedicated HFpEF clinics may not be adequate in addressing the multifaceted aspects of HFpEF as clinic activities concentrated primarily on cardiological measures. Although the small cohort and short follow-up period are important limitations, this study reminds clinicians that HFpEF patients are more at risk of non-cardiac than HF-related events. We have therefore proposed a pragmatic framework that can comprehensively deliver the modern guideline-directed recommendations and management of non-cardiac comorbidities through a multidisciplinary approach.

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“…From our experience, some of these patients may be better served in a joint cardio-renal clinic, which we also run alongside the HFpEF clinic. 10 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%