Introduction The progression of a community diagnosis of heart failure portends a poor clinical prognosis, highlighting the need to consider advanced heart failure therapies or palliative care. Defining those most at risk of syndrome progression requiring the need for hospitalisation allows heightened clinical focus on this at risk and to focus resources on high risk patients within the framework of a disease management programme (DMP). The purpose of this project was to define the natural history of patients diagnosed with heart failure in the outpatient setting and managed in a DMP to determine the phenotype of those most likely to progress using baseline metrics. Progression was defined as requirement of hospitalisation for acute decompensated heart failure, an accepted concerning clinical event.
Methods A retrospective analysis of new community diagnoses of heart failure were followed over time in our heart failure unit. A rapid access clinic is provided in this centre for potential new community diagnoses of heart failure referred in by family physicians. Subsequent confirmed cases of heart failure are followed within a cardiologist led disease management programme. Heart failure progression is defined as the need for hospital admission to manage acute decompensated heart failure.
Results 607 patients were reviewed [age: 76.7±11 years; 290 (47.8%) male; 196 (36%) heart failure with a reduced ejection fraction (HFrEF); 345 (64%) heart failure with a preserved ejection fraction (HFpEF); mean brain natriuretic peptide (BNP) 343.4±465.6 pg/ml ; mean creatinine 105.7±56.1 μmol/L]. 57 (9.4%) patients demonstrated progression of HF with a mean follow up: 4.3±3.3 years. The annual incidence of progression was 13 patients (2.19%). Univariate predictors of progression included mean BNP [468.4±502.2 pg/ml versus 329.7±459.9 pg/ml) (p<0.001)]; mean creatinine [114.2±40.5 versus 104.8±57.5 (p<0.0114)]; E/e’ [11.6±4.9 mmHg versus 10.1±4.3 mmHg (p=0.0467)] in progression to hospitalisation versus non-progression respectively. Multivariate predictors included left atrial volume index (LAVI) [66.9±32.3 mL/m2 versus 47.7±20.5 mL/m2 (p<0.001); OR 1.03 (95%CI: 1.01, 1.05; p=0.014)] in progression to hospitalisation versus non-progression respectively.
Conclusion A Disease management programme for patients with a community diagnosis of heart failure are less likely to progress to hospitalisation affecting marginally over 2% of the population per year. The strongest indicator of risk for disease progression was left atrial size indicating that this group would likely benefit from intense follow up.
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