Background Recurrent hospitalisation for acute decompensated heart failure (ADHF) is a concerning prognostic sign and usually underlines the need to consider advanced heart failure (HF) therapy or palliative care. Multidisciplinary disease management programs (DMP) are now recognised as the optimal method to deliver state of art HF care to those surviving an ADHF admission. What is unclear are the characteristics of those managed in a DMP likely to display a downward course in disease trajectory and thereby in need of a change in management strategy.
Methods We recruited patients entering our DMP following an admission for ADHF. Patients were followed over time to determine what percentage of them defined features of disease progression (defined as 2 subsequent ADHF admission within a 6 month period) compared with those demonstrating a more stable course.
Results 1984 patients were followed for an average of 3.6 years in our DMP post admission with ADHF. Mean age was 73 years old. 58% were male. Of these 493 had heart failure with a preserved ejection fraction (HFpEF) and 1239 had heart failure with a reduced ejection fraction (HFrEF). 264 patients demonstrated heart failure disease progression at an annual incidence of 3.7% per year. On multivariate analysis the strongest indicators of progression to refractory heart failure were B-type natriuretic peptide (BNP) and renal function as estimated by creatinine, with stable raised BNP being the strongest predictor of disease progression. The optimal stable BNP to differentiate high and low risks was approximately 440 pg/ml.
Conclusion Patients managed in a multidisciplinary disease management program showed a low rate of annual progression of HF syndrome as defined by recurrent hospitalisations. This highlights the importance of referring patients at risk of recurrent hospitalizations to a DMP to help improve patient outcomes. Persistently high stable BNP and impaired renal function were the strongest predictors of disease progression.
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