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Clinical course and therapy optimization of patients after discharge from a specialized heart failure clinic

*Author for correspondence: Tel.: +45 386 33641;

E-mail Address: junjing.su@regionh.dk

https://orcid.org/0000-0001-7450-0938

Department of Medicine, Section of Cardiology, Glostrup Hospital, Glostrup 2600, Copenhagen, Denmark

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Anders Barasa

Department of Medicine, Section of Cardiology, Glostrup Hospital, Glostrup 2600, Copenhagen, Denmark

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Charlotte Andersson

Department of Medicine, Section of Cardiology, Boston Medical Center, Boston University School of Medicine, MA 02118, USA

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Jawdat Abdulla

Department of Medicine, Section of Cardiology, Glostrup Hospital, Glostrup 2600, Copenhagen, Denmark

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Published Online:19 Jun 2023https://doi.org/10.2217/fca-2022-0135

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Abstract

Aim: We aimed to describe the clinical course of patients with heart failure with reduced ejection fraction (HFrEF) after discharge from the heart failure clinics (HFC). Patients & methods: We reviewed the hospital's records of 610 patients that were discharged between 2013 and 2018 from the HFC at a single centre. Patients with no recurrent contact to ambulatory cardiac care were invited to an echocardiographic assessment. Results: Of the survivors, 72% were re-referred after discharge. Nearly 30% of the patients with no recurrent contact with ambulatory cardiac care had persistent HFrEF and further therapeutical optimizations were indicated in half of them. Conclusion: This highlights the importance to identify high-risk patients that would benefit from extended management in the HFC.

Plain language summary

What is this summary about?

In Denmark, it is standard practice to discharge patients with heart failure from heart failure clinics to primary care after achieving optimized guideline-directed medical therapy. However, little is known about their subsequent clinical course and whether their treatment could be further optimized. To answer that question, we reviewed the hospital's records of heart failure patients that were discharged between 2013 and 2018.

What were the results?

Of the 610 heart failure patients that were discharged from our clinic, 30% had died; 72% of the survivors were re-referred to cardiac clinics in the interim period. Nearly 30% of the patients with no recurrent contact with cardiac clinics had persistent heart failure and further therapeutical optimizations were indicated in half of them.

What do the results mean?

Deaths and re-referral to cardiac clinics accounted for the majority of the heart failure patients that were initially discharged; while further intervention was indicated in half of the stable patients that had no recurrent contact with cardiac ambulatory care. This highlights the challenges in identifying high-risk patients that would benefit from an extended management programme in the heart failure clinic and the importance of following up heart failure patients despite initial optimized therapy.

Tweetable abstract

In Denmark, it is standard practice to discharge heart failure patients from cardiac clinics to primary care. However, re-referral is common among discharged patients, while further optimization was indicated in many that had no recurrent contact with cardiac ambulatory care.

Graphical abstract

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Papers of special note have been highlighted as: • of interest

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Vol. 19, No. 5

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History

Received 24 December 2022

Accepted 16 May 2023

Published online 19 June 2023

Published in print April 2023

Information

Keywords

Author contributions

J Abdulla designed the study, J Su and J Abdulla acquired and analysed the data. All authors interpreted the data. J Su drafted manuscript and all authors revised the manuscript critically for important intellectual content. All authors have approved the final version of the manuscript to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Acknowledgments

We thank nurse M Bülow for her enormous efforts in patient recruitment and interviews as well sonographers B Brauner and H Danielsen for their invaluable assistance in performing and analysing echocardiographic examinations.

Financial & competing interests disclosure

The study was supported by Novartis HealthCare A/S. The funder had no role in the preparation of the manuscript or decision to publish. JA has received speaker fees from Novartis HealthCare A/S. AB has received speaker fees, consulting fees and travel support from Novartis HealthCare A/S. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The study was approved by the Capital Region Committee on Health Research Ethics, Denmark (no. H-19030187), all patients gave written informed consent, and the study was performed according to the Helsinki Declaration II. Patient screening and data registration were carried out in accordance with the Danish Data Protection Legislation.

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