Authors (including presenting author) :
Cheng YH(1), Chan SC(1), Wong CW(1), Chan YH(1), Lam CS(1)
Affiliation :
(1)Dept of Medicine and Geriatrics, Pok Oi Hospital
Introduction :
Heart failure is a collection of diseases whereby the pumping of blood by the heart is impaired. It is the common endpoint of various insults with myocardial infarction as the leading cause. With the aging population and increasing efficacy of medical therapies that prolonged the lives of cardiac patients, heart failure is a common condition seen in the acute hospital setting.The burden of congestive heart failure (CHF) in the modern society of Hong Kong is increasing annually. A local study in 1997 estimated the overall incidence rate per 1000 men and women was 5.7 and 4.8 respectively. Patients would benefit from a standardized guideline oriented inpatient hospital care. Clinical pathways for heart failure have been developed, but these models have not been evaluated in the local community setting.
Objectives :
Here, we sought to assess the effectiveness of implementation of a clinical heart failure pathway by evaluating the use of heart failure medications, length of stay, rate of readmission and mortality in patients with congestive heart failure at Pok Oi Hospital.
Methodology :
Heart failure pathway was implemented in Pok Oi Hospital since Dec 2015. We retrospectively studied a total of 185 patients (mean age 66.5 ± 10.1) with diagnosis of congestive heart failure in a community hospital between January 2015 and December 2016. Cases will be excluded from the program if they have any of the following: 1) advanced stage renal disease (baseline Cr >= 300 mmol/L); 2) other end stage organ failure apart from heart failure (e.g. advanced stage chronic obstructive pulmonary disease, advanced dementia); 3) expected survival < 1 year (e.g. terminal malignancy). Patients were divided into two groups, 93 patients who were mainly managed by the general medical team and 92 patients who were recruited into the pathway, all reviewed by the cardiac team with suggested management. We conducted detailed reviews to determine and compare the use of evidence based heart failure medications, risk factors control status, length of stay, rate of readmission and death rate.
Result & Outcome :
Use of heart failure pathway in the local hospital setting was associated with an increase in use of heart failure medications as well as reduction in heart failure readmission and cardiac mortality.
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