Effectiveness of heart failure clinic care in Rayong hospital.

Abstract

Introduction : Severe congestive heart failure is a critical clinical syndrome, as more than one-third will be re-hospitalized or dead within 90 days post-discharged especially in patients who has systolic dysfunction (LVEF less than 40 Percent) Multiple drugs are usually prescribed in this patients but the result is quite unsatisfied due to several factors including bio-psychosocial factor. Rayong hospital heart failure clinic was founded to take care severe heart failure patients by multidisciplinary team since October 2008 for better quality of care.

Objective : To study the outcome of heart failure patients who were care by multidisciplinary team.

Method : Descriptive study was applied to monitor result of Rayong hospital heart failure clinic compare pre-post heart failure clinic care from October 1st,2008 to October 1st, 2010. The criteria used to enroll our patients to this study was second hospitalization due to congestive heart failure or ejection fraction by echocardiogram less than 40 Percent. Baseline characteristic was collected. Re-hospitalization and death rate due to
congestive heart failure, NYHA functional capacity had been studied at 30 days, 90 days and 1 year.

Result : Totally 111 patients was enrolled. They were classified as ejection fraction (EF) <40 Percent 79 Percent, valvular heart disease (VHD) 15 Percent, hypertrophic cardiomyopathy (HCM) 5.4 Percent and primary pulmonary hypertension (PHT) 1.8 Percent , Mean hospitalization due to congestive heart failure was 2.69 event/year (299 admission) before include to clinic, Heart failure medicine was applied by standard care.NYHA Function class I increased 42 Percent to 81 Percent and Function class III decreased from 12 Percent to 0 Percent in 90 days before enrolling into heart failure clinic, 27 events in 18 patients were re-hospitalized due to congestive heart failure in first year, Mean hospitalization due to congestive heart failure before enrolling into clinic was 0.3 event/year (24 admissions). 80 patients (72 Percent) was symptom/death free in first year. Mortality in first year was 12 Percent (14 patients) 42 Percent was heart failure related death, 31 Percent (6 patients) was unknown or sudden cardiac death and 26 Percent (5 patients) was non-cardiac death

Conclusion : Congestive heart failure was high risk clinical syndrome. Mortality and re-hospitalization were remaining high. Congestive heart failure care needs holistic approach to achieving maximal quality care. Best quality heart failure care can reduce hospitalization days significantly decrease mortality cost and health care work load. Heart failure clinic by multidisciplinary care (Including nurse, pharmacist and physician) proves
very helpful in congestive heart failure care.

Keyword : Congestive heart failure, heart failure clinic, Rayong