Caring at Cardiology Clinic versus Heart Failure Clinic: Impact of Implementation of Guideline-Directed Medical Therapy in Heart Failure with Reduced Ejection Fraction in Outcomes of Death and Heart Failure Readmission Caring at Cardiology Clinic versus Heart Failure Clinic

Abstract

Objective: This study aimed to determine whether the heart failure (HF) clinic setting can improve guideline-directed medical therapy (GDMT) use and reduce HF readmission and mortality rates in patients with heart failure with reduced ejection fraction (HFrEF).
Methods: This was a retrospective cohort study including patients with HFrEF admitted to Vajira Hospital between May 2016 and December 2021. Data were collected from electronic medical records to compare the usage of GDMT, including beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs)/ angiotensin receptor blockers (ARBs)/ angiotensin receptor-neprilysin inhibitors (ARNIs), mineralocorticoid receptor antagonists (MRAs), and sodium glucose transporter 2 inhibitors (SGLT2s), after discharge from the inpatient department at 1-, 3-, 6-, and 12-month follow-up between the HF clinic and general cardiology clinic groups. Moreover, readmission, mortality rates and composite endpoint of mortality and HF admission rate at the 1-year follow-up were recorded.
Results: In total, 234 patients with HFrEF were included in this study (88 in the HF clinic group and 146 in the general cardiology clinic group). After 1-year follow-up, the incidence rates of mortality in the HF clinic and general cardiology clinic groups were 3.45 and 11.66 per 100 person-years, respectively (p = 0.040), and the incidence rates of readmission were 23.77 and 79.01 per 100 person-years, respectively (p < 0.001). The HF clinic group showed reduced risk for the composite outcome of readmission and mortality (0.37, 95% confidence interval (CI): 0.23–0.60) (p < 0.001), mortality (0.30, 95% CI: 0.09–1.02) (p = 0.054), and readmission (0.33, 95% CI: 0.21–0.53) (p < 0.001) than the general cardiology clinic group. At the 12-month follow-up, the HF clinic could up-titrate GDMT to target doses higher than the general cardiology clinic (beta-blockers 68.20% vs. 32.90% (p < 0.001), ACEIs/ARBs/ARNIs 12.50% vs. 3.40% (p = 0.003), MRAs 9.10% vs. 4.10% (p = 0.001), and SGLT2s 4.50% vs. 7.50% (p = 0.648)).
Conclusion: Patients in the HF clinic showed a significant improvement in survival and HF readmission rates and had a higher use of GDMT with a shorter duration to achieve the target doses.