5 Optimising heart failure care by multi-disciplinary heart failure clinic (MHFC)

According to the Hospital Authority’s Statistical Report 2015–2016, heart failure (HF) was the leading cause of admission in Cardiology. The total number of HF admissions have increased by 14% in 10 years. Moreover, increasing frequency of acute decompensated HF has resulted in higher rates of hospitalisation and mortality. It is recognised that the 30 day readmission rate can be 25%–50% following hospital discharge.1 Current guideline recommends that HF patients should be managed by a multi-disciplinary care team to reduce HF-related hospitalisation.2 In fact, the establishment of multi-disciplinary heart failure clinics have been associated with reduction in rates of readmission3–5 and all-cause mortality.5 In June 2017, we launched the Multi-disciplinary Heart Failure Clinic (MHFC) at Prince of Wales Hospital, Shatin, with two dedicated clinic sessions per week. Self-ambulatory patients in HF with reduced ejection fraction or HFREF (EF ≤40%) and New York Heart Association (NYHA) class II-IV who had recent HF-related hospitalisation were followed. Education on self-monitoring of symptoms, fluid restriction and medication adherence were done by a dedicated HF nurse. Subsequent optimisation of guideline-directed medical therapy was done by the cardiologist. At 6 month follow-up, NYHA class improved from I to II in the majority of patients (figure 1; p=0.029). In addition, the 30 day readmission rate decreased from 68% to 12% (figure 2; p<0.05). Abstract 5 Figure 1 Distribution of NYHA functional class in heart failure patients after 6 months of care and follow-up in the multidisciplinary heart failure clinic Abstract 5 Figure 2 Hospital admission rates 90 days before and 90 after starting care and follow-up at the multidisciplinary heart failure clinic In conclusion, the establishment of MHFC can improve HF-related hospitalisation and patients’ symptomatology. Our local study echoes the findings of a recent meta-analysis.5 References Adib-Hajbaghery M, Maghaminejad F, Abbasi A. The role of continuous care in reducing readmission for patients with heart failure. J Caring Sci 2013;2:255–267. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; ESC Scientific Document Group. 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. Eur Heart J 2016;37:2129–2200. Ducharme A, Doyon O, White M, Rouleau JL, Brophy JM. Impact of care at a multidisciplinary congestive heart failure clinic: a randomized trial. CMAJ2005;173:40–45. Martineau P, Frenette M, Blais L, Sauvé C. Multidisciplinary outpatient congestive heart failure clinic: impact on hospital admissions and emergency room visits. Can J Cardiol2004;20:1205–1211. Gandhi S, Mosleh W, Sharma UC, Demers C, Farkouh ME, Schwalm JD. Multidisciplinary heart failure clinics are associated with lower heart failure hospitalization and mortality: systematic review and meta-analysis. Can J Cardiol2017;10:1237–1244.