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Heart Failure early post discharge appointment – a single center experience
Session:
Posters (Sessão 3 - Écran 5) - Insuficiência Cardíaca - Clínica
Speaker:
Inês Fialho
Congress:
CPC 2023
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.6 Acute Heart Failure - Clinical
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Inês Fialho; Mariana Passos; Filipa Gerardo; Carolina Mateus; Joana Lima Lopes; Inês Miranda; Marco Beringuilho; Ana Oliveira Soares; David Roque
Abstract
<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Background: </strong>Heart Failure (HF) guidelines suggest performing a follow-up visit within 1-2 weeks after discharge to monitoring signs and symptoms of HF and to evaluate treatment side effects. This approach has been associated with a lower 30-day readmission rates in retrospective studies.</span></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Objectives: </strong>To describe the role of HF early post discharge appointment (EPDA) in the management of HF patients and to evaluate prognostic factors after HF hospitalization.</span></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Methods: </strong><span style="color:black">Prospective registry<strong> </strong>of consecutive patients evaluated in the HF EPDA of a single center between March 2021 and September 2022. </span>Demographics, blood tests results, treatment decision, and HF events at 90 days were recorded.</span></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Results: </strong>A total of 153<strong> </strong>patients were included, 63.4% males (n=97), mean age of 65.7 ± 13.0 years. The mean time between hospital discharge and EPDA was 13.4 ± 5.7 days. Left ventricle ejection fraction was reduced in 83.6% (n=127) of patients. Guideline medical directed treatment (GMDT) prescribed at discharge, increase in HF drugs doses at EPDA, and maximal drug doses are presented in Table 1. At EPDA, 34.3% (n=35) of patients presented drug adverse effects: 17.5% had hyperkalemia (n=22), 3.9% had hypotension (n=6) and 9.9% acute kidney injury (n=12). After EDPA, 11.2% (n=17) of patients were rescheduled to another EDPA in one week, 90.1% (n=137) were followed-up in standard HF ambulatory program, 1.3% (n=2) were referred to the emergency department (ED), and 1.3% (n=2) were hospitalized. Serum creatinine level (1.10 [0.87 – 1.36] mg/dL vs 1.40 [1.09 – 1.95] mg/dL, p<0.001), serum C cystatin level (1.50 [1.25 – 1.98] mg/dL vs 1.97 [1.54 – 2.46] mg/dL, p=0.007) and NTproBNP level at EPDA (1859 [977 – 4877] mg/dL vs 5928 [2817 – 11957] mg/dL, p=0.013) were associated with 90-days HF events (ED visit or HF hospitalization). A NTproBNP level at EDPA above 2400 pg/mL adjusted to a C cystatin was a strong predictor of 90-days HF events (OR 9.855, 95% CI 2.657 – 36.550, p=0.001). This model yielded a good prognostic performance (AUC 0.790, CI 95% 0.689-0.890, p<0.001). </span></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Conclusions: </strong><span style="color:#000000">Early evaluation of HF patients after discharge allows GMDT titration and early detection of drug adverse effects. NTproBNP and kidney function early after discharge are strong predictors of 90-days HF events, pointing out to which patients will benefit most of an early follow-up appointment.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10.5pt">Table 1</span></strong><span style="font-size:10.5pt"> - Guideline medical directed treatment (GMDT) patterns of prescription at discharge and at early post discharge appointment. ACE, angiotensin converting enzyme; ARA, aldosterone receptor antagonist, MRA, mineralocorticoid receptor antagonist.</span></span></span></span></p>
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