Meaningful management of heart failure at Epworth.

Abstract

BACKGROUND: In 2014 Victorian Cardiac Outcomes Registry (VCOR) piloted a project to develop a minimum dataset for use in patients presenting to 16 hospitals with acute decompensating heart failure (ADHF). In 2016 Epworth was the only private hospital to be invited to participate in a one month snapshot of patients with a purpose of collecting epidemiological data covering pre-admission, admission and post discharge transitional care. It aimed to identify current, specific issues of in-patient care, discharge planning and appropriate out-patient care in order to optimize the utilization of resources. 'Given that two thirds of the costs of managing heart failure relate to hospitalization episodes, considerable effort has been made to detect deterioration in clinical status early to prevent need for hospitalization' (Acute HF Data Definitions, VCOR, version 1.2, page 7). RESULTS: At Epworth Richmond 36 patients were identified (4th out of 16 in enrollment numbers). All patients were given the choice of opting out from the snapshot. Baseline data, admission treatment and discharge status was then collected. Follow up of all registered participants was completed 30 days post discharge. At Epworth, 58.3% of participants were admitted, through ED, treated by cardiologists, with nearly all having a history of HF. 66.7% were previously hospitalized and were an older average population than the cohort. The results indicated there was a high use of IV diuretics, appropriate use of inotropes, low use of ACE inhibitors on admission (which increased by discharge) and underutilization of beta blockers. Only 2.7% of patients were discharge to a heart failure specific outpatient program with only 11.1% going to cardiac (non-HF specific) rehabilitation. Inpatient mortality was 11.1% and 30 day readmission rate was 5.6%. CONCLUSION: The results indicates the need for a formalized heart failure clinic to maximize HF patient outcomes and minimize the need for hospitalization through better education and in-community management.