The impact of an integrated heart failure service in a medium-sized district general hospital

Abstract

ObjectivesAssessing the impact of a new integrated heart failure service (IHFS) in a medium-sized district general hospital (DGH) on heart failure (HF) mortality, readmission rates, and provision of HF care.MethodsA retrospective, observational study encompassing all patients admitted with a diagnosis of HF over two 12-month periods before (2012/2013), and after (2015/2016) IHFS establishment.ResultsTotal admissions for HF increased by 40% (385 vs 540), with a greater number admitted to the cardiology ward (231 vs 121). After IHFS implementation, patients were more likely to see a cardiologist (35.1% vs 43.7%, p=0.009), undergo echocardiography (70.1% vs 81.5%, p<0.001), be initiated on all three disease modifying HF medications (angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB) and mineralocorticoid receptor antagonists (MRA)) in the heart failure with reduced ejection fraction (HFrEF) group (42% vs 99%, p<0.001) and receive specialist HF input (81.6% vs 85.4%, p=0.2). Both 30-day post-discharge mortality and HF related readmissions were significantly lower in patients with heart failure with preserved ejection fraction (HFpEF) (8.9% vs 3.1%, p=0.032, 58% reduction, p=0.043 respectively) with no-significant reductions in all other HF groups. In-patient mortality was similar. Length of stay in Cardiology wards increased from 8.4 to 12.7 days (p<0.001).ConclusionEstablishment of an IHFS within a DGH with limited resources and only a modest service re-design has resulted in significantly improved provision of specialist in-patient care, use of HFrEF medications, early heart failure nurse follow-up, and is associated with a reduction in early mortality, particularly in the HFpEF cohort, and HF related readmissions.

Heart failure with mildly reduced and preserved ejection fraction: A review of disease burden and remaining unmet medical needs within a new treatment landscape

“…There was no significant difference in in-hospital mortality between the 2 cohorts for HFpEF ( P = 0.472). Notably, for HFpEF, 30-day post-discharge mortality decreased from 8.9% (2012/2013) to 3.1% (2015/2016) ( P = 0.032) [ 75 ]. Improved mortality was prominent among cardiology ward patients, possibly due to optimised fluid status and extended inpatient stays [ 75 ].…”

“…Notably, for HFpEF, 30-day post-discharge mortality decreased from 8.9% (2012/2013) to 3.1% (2015/2016) ( P = 0.032) [ 75 ]. Improved mortality was prominent among cardiology ward patients, possibly due to optimised fluid status and extended inpatient stays [ 75 ]. The Swedish registry data (SwedeHF) [ 44 ] revealed that HFpEF patients on beta-blockers had lower mortality rates at 1, 3, and 5 years (16%, 37%, and 53%, respectively) with an incidence rate of 157 per 1000 patient-years (95% CI: 153–162) compared with non-beta-blocker users.…”

Kolkata-Coventry comparative registry study of acute heart failure: an insight into the impact of public, private and universal health systems on patient outcomes in low–middle income cities (KOLCOV HF Study)

“…NICOR recommends that >85% of AHF cases should receive cardiologist input and >60% to be admitted to cardiology, both of which are associated with improved mortality for HFrEF and HFpEF 13 36. AGH exceeded these KPIs, followed by NRS and least with UHCW.…”