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The Role of Multidisciplinary Heart Failure Outpatient Clinics in the Management and Prognosis of Patients with Advanced Heart Failure
Session:
SESSÃO DE POSTERS 22 - LVAD / TRANSPLANTAÇÃO CARDÍACA
Speaker:
Patrícia Bernardes
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Cartazes
FP Number:
---
Authors:
Patrícia Bernardes; Sara Gonçalves; Jéni Quintal; Tatiana Duarte; Hugo Viegas; Pedro Carreira; Ana Sousa; Crisálida Ferreira; Andreia Soares; Dina Ferreira; Ermelinda Pedroso; Filipe Seixo
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Advanced heart failure (AHF) is defined as the persistence of severe symptoms despite optimized medical, surgical, and device therapies with a high risk of adverse outcomes. Nevertheless, not all pts are eligible for advanced treatments, such as heart transplantation or long-term mechanical circulatory support. Multidisciplinary HF outpatient clinics may help improving outcomes in these complex pts.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> To demonstrate the impact of our multidisciplinary HF unit on HF hospitalizations and emergency department visits in pts with advanced HF in a real-world setting.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> This retrospective observational study included 74 outpatients with AHF followed at our HF unit, between September 2020 - September 2024. A “same day clinic” philosophy is provided with a 5 days/week open access clinic. Hospitalizations, HF events and all-cause mortality were analysed. AHF was defined according to the 2018<em> Position statement from Heart Failure Association of the European Society of Cardiology for Advanced Heart Failure.</em></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>This cohort included 74 pts with a mean age of 72 years (SD = 12.4), and a 68% male predominance. The mean follow-up was 18.5 months (± 9.2). Most pts (93%) had a current NYHA functional class of III or IV. A high prevalence of cardiovascular comorbidities was observed, including hypertension (73%), diabetes mellitus (55%), chronic kidney disease (39%), and obesity (32%). Ischemic cardiomyopathy was the etiology of HF in 46% of pts. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The mean NT-proBNP level was 10685 pg/mL and mean serum creatinine was 2.2 mg/dL. Regarding HF subtypes, 59.5% had HFrEF, 16.2% had HFmEF, and 24.3% had HFpEF. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Although 68 outpatients (91.9%) required an urgent visit for intravenous diuretic therapy (mean 5.9 ± 5.3 visits per pt), only 17 pts (23%) were hospitalized for HF. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Approximately 44.6% of pts were on levosimendan, which was associated with lower mortality (p = 0.005). Death from any cause occurred in 36 pts (48.6%), traducing pt severity, nevertheless death from cardiovascular causes only occurred in 7 pts (9.5%).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>Our cohort demonstrated high rates of all-cause mortality and decompensation, consistent with those reported in pts with advanced or worsening HF. However, hospitalizations for HF were low. The role of our HF unit and multidisciplinary team was crucial, as most episodes of worsening HF were managed without hospitalization. We conclude that open access to specialized HF care can significantly improve outcomes in pts with AHF.</span></span></p>
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