CCCardiol CroatCardiologia CroaticaCardiol. Croat.1848-543X1848-5448Croatian Cardiac SocietyCC_12(9-10)_35110.15836/ccar2017.351Extended AbstractResults of a 6-month intensive outpatient management programme for patients with chronic heart failure – a pilot studyhttp://orcid.org/0000-0003-3490-5505DošenDenis1http://orcid.org/0000-0002-0263-2920DošenDubravko1http://orcid.org/0000-0002-2641-4768DošenDejan2http://orcid.org/0000-0003-2633-3439FabijanovićDora2http://orcid.org/0000-0002-4772-5549ČikešMaja2http://orcid.org/0000-0001-9101-1570MiličićDavor2Private Cardiovascular Clinic “Dr. Došen”, Karlovac, CroatiaUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, CroatiaAddress for correspondence: Denis Došen, Poliklinika dr. Došen, Trg Petra Zrinskog 7, HR-47000 Karlovac, Croatia. / Phone: +385-98-548-540 / E-mail: denisdosen@gmail.com102017129-1035135224092017260920172017Croatian Cardiac SocietyKeywords: outpatient heart failure clinicadvanced heart failuredrug therapy optimization
Introduction: Heart failure (HF) has been singled out as a staggering clinical and public health problem, associated with significant mortality, morbidity, and healthcare expenditures. Heart failure patients often experience a loss of productivity and quality of life. (1) This pilot study evaluated the effectiveness of a multidisciplinary, outpatient HF clinic during 6 months period. Our goal was to determine whether an intensive intervention at a HF clinic improves patient’s functional status (New York Heart Association (NYHA) class), echocardiographic parameters, and levels of NT-proBNP. Patients with optimal drug therapy at the start and at the end of the study were also evaluated.
Patients and Methods: Our follow-up consisted of 8 scheduled patient contacts - initial visit at day 1, telephone contact at day 3, and visits to the clinic at weeks 1, 3, 5, 7 and at months 3 and 6. Verbal and written comprehensive education, optimization of treatment, easy access to the clinic, and advice for symptom monitoring and self-care were provided. Echocardiography study, six-minute walk test (6MWT) and levels of NT-proBNP were performed on an initial and the last visit. For group comparison Pearson chi-square, Fischer’s Exact test, Wilcoxon Signed Ranks Test and Paired Samples T-Test were used.
Results: A total of 35 HF pts (mean age 76±6 years, 40% male) with various comorbidities (atrial fibrillation (57%), diabetes mellitus (32%), arterial hypertension (74%), chronic obstructive pulmonary disease (6%) diagnosed per the current guidelines were prospectively assessed in the period of 6 months. In follow-up period significant reduction of body mass index, average heart rate and systolic blood pressure was observed (Table 1). Echocardiography study showed improvements in systolic pulmonary pressure and left ventricular ejection fraction (Table 2).
Patients characteristics.
Segment
Visit 1
Visit 6months
P-value
BMI (mean ± SD)
31.42 ± 5.45
30.70 ± 4.87
0.02
SBP (mean ± SD)
127 ± 22
119 ± 9
0.02
HR (mean ± SD)
76 ± 21
69 ± 11
0.03
6MWT (median, IQR)
200 (82-280)
270 (170-325)
< 0.01
NT-proBNP (median, IQR)
1873 (929-3301)
1676 (434-4032)
0.183
NYHA (%)IIIII
20 (59)14 (41)
32 (97)1 (3)
< 0.01
OMTBeta-blockers (%)
32 (94)
31 (92)
0.52
ACEI / ARBs (%)
21 (62)
23 (72)
0.30
MRA (%)
8 (24)
23 (72)
< 0.01
ARNI (%)
3 (9)
5 (16)
0.46
Diuretics (%)
33 (99)
32 (97)
1.0
BMI = body mass index, SBP = systolic blood pressure, HR = heart rate, 6MWT = 6 Minute Walk Test, NYHA = New York Heart Association, OMT = optimal medical therapy, ACEI = Angiotensin-converting-enzyme inhibitor, ARBs = Angiotensin receptor blockers, MRA = Mineralocorticoid receptor antagonist, ARNI = Angiotensin Receptor-Neprilysin Inhibitors
Conclusion: A HF outpatient clinic involving an intensive intervention by a clinician, substantially improves patient’s functional status (NYHA class, 6MWT) as well as echocardiographic parameters. We also showed that mineralocorticoid receptor antagonists are still underutilized in the treatment of heart failure in our region and that further improvements in their prescribing are needed.
LITERATUREPonikowskiPVoorsAAAnkerSDBuenoHClelandJGCoatsAJAuthors/Task Force Members. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. . 2016 Jul 14;37(27):2129–200. 10.1093/eurheartj/ehw12827206819