Reducing Heart Failure Rehospitalization by Post-Discharge Multidisciplinary Heart Failure Clinic: Experience from the Prince of Wales Hospital

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Authors (including presenting author) :
KKH Kam(1), A Yu(1), E Fung(1), YT Fan (1), YS Chan(1), APW Lee (1)
Affiliation :
(1) Division of Cardiology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong
Introduction :
Patients hospitalized for heart failure and reduced ejection fraction (HFrEF) are at risk of recurrent hospitalizations for decompensated HF during the initial post-discharge period with a 30-days readmission rate of up to 50%.
Objectives :
We aim to evaluate the impact of a multidisciplinary heart failure clinic (MHFC) transitional care program on HF rehospitalization, New York Heart Association (NYHA) functional class, and left ventricular systolic function on echocardiography among patients admitted to the Prince of Wales Hospital.
Methodology :
Patients with HFrEF (EF<40%), NYHA class II to IV, and had a recent HF hospitalization within the past 6 months were recruited. Exclusion criteria were severe primary valvular abnormalities, limited life expectancy (<1y), and non-ambulatory premorbid status. The MHFC Program emphasized on post-discharge (within 30 days) self-care patient education and support, nurse-led titration of drugs, and adherence to guideline-based care. Patients were followed up at the MHFC every 2 to 4 weeks until optimization of medication and stabilization of clinical status were achieved, and then discharged to the cardiology clinic for further care.
Result & Outcome :
From June 2017 to June 2018, 68 patients (56 men, age, 65±5 years) were recruited. At 6 months follow-up, there were significant improvements in 30-day HF hospitalization rate (pre-MHFC, 68% vs post-MHFC, 12%, p<0.001), mean NYHA class I to II (pre-MHFC, 68% vs post-MHFC, 81%, p=0.03), and LVEF (pre-MHFC, 31% vs post-MHFC, 41%, p<0.05). The reduction of HF hospitalization translates into an estimated net saving of HK$1.2M (assuming a daily cost of HF in-patient care of HK$5000). In conclusion, multidisciplinary heart failure clinic transitional care program focusing on adherence to guideline-based care, individualized instruction, and early follow-up in the immediate post-discharge period reduces HF readmissions, improves patients’ functional status, and potentially saves cost in a local tertiary hospital setting.

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