Effect of a heart failure clinic on survival and hospital readmission in patients discharged from acute hospital care

Abstract

Ambulatory care by physicians especially devoted to the management of heart failure (HF) has been reported to have beneficial effects. The aim of this work was to assess the effect of outpatient management at a HF clinic, as compared with care by the usual assistant physician, on prognosis of HF patients. In this non-randomised study, we prospectively followed 339 patients after a hospitalisation index for HF, in order to compare prognosis between two groups of HF patients according to the ambulatory assistance setting: either a specific outpatient clinic (ns157) or the usual assistant physician (ns182). The outcomes assessed were all-cause death or cardiac-cause rehospitalisation during the first month after discharge and survival over the longer term. The risk of dying or being readmitted during the first month after discharge was significantly lower in patients followed at the HF clinic (adjusted odds ratio 0.23; 95% CI 0.12-0.46). Patients followed in the HF clinic also had an independent significantly lower hazard of dying during a longer-term follow up of average length 373 days (adjusted hazard ratio 0.52; 95% CI 0.34-0.81). The results support the fact that a multidisciplinary and permanently available medical staff might be of relevance in improving outcomes in HF patients. ᮊ

Prevalence and characteristics of diabetic patients in a chronic heart failure population

“…These differences most likely reflect the difference in DM prevalence between Europe and the US, as well as the use of different diagnostic criteria for DM. Although not focusing on DM, several studies from heart failure clinics and different heart failure management programs have reported a DM prevalence, which ranged from 21% to 30% in the European studies [26][27][28], and with the same pattern of higher frequencies (28%-52%) in the US populations [29][30][31][32]. However, most of these previous studies were randomised, with selected populations using different inclusion criteria, as in the study by Rich et al, only including patients N70 years of age [29].…”

“…Other studies only included NYHA class III/IV patients [26,28], or used several exclusion criteria [33]. The diagnosis of CHF was often made on a clinical basis [28,29,31], and only some of the studies used echocardiography [15,27,30]. Thus, comparison of the DM prevalence is difficult, due to differences in selection of the patient populations, and use of different diagnostic criteria for CHF.…”

Clinical Interventions to Reduce Preventable Hospital Readmission After Percutaneous Coronary Intervention

“…[13][14][15][16][17] We have been encouraging cardiology providers to see patients within 2 weeks of discharge, and, in keeping with available data, have made continuity and access to the specialist a priority. [12][13][14][15][16] An urgent access clinic was established as a mechanism to ensure patient access to busy outpatient providers and provide focused care after acute cardiovascular events. In addition to providing specialist physician care, a pilot using a cardiology pharmacist for medication reconciliation phone calls resulted in identification of several errors or problems with patient receipt of correct medications.…”

Variability in use of IV nitrates and diuretics in acute HF: a ‘virtual patient’ clinical decision-making study

“…Follow-up by cardiologists or specialist nurses was associated with reduced death rates in England and Wales. 3 Studies have shown reductions in rates of rehospitalization 113,145,146 and death, 135,145,147 and improvement in quality of life, 146 during follow-up at a specialist heart failure clinic compared with usual care.…”