A demographic study to profile non-attenders at a single centre heart failure outpatient clinic

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Nonattendance is a source of inefficiency increasing waiting lists with potential secondary effects on the health status of non-attenders. This is true for patients in heart failure (HF) management programmes with nonattendance reducing the opportunity for prevention intervention &potentially increasing the risk of HF re-hospitalisation. Methods A retrospective analysis of trends of non-attendance of appointments to a single centre HF disease management programme over 36 months. Variables which influence missed appointments such as day of week & comparison between the first & second 6 months of the year were analysed. Patients who did not attend (DNA) their HF appointments (index cases) over 12 months (January–December 2021) were compared with a sample of patients who attended the same clinics (using a computer-generated randomisation technique). Variables which influence missed appointments were compared (age, gender, new/return status, history of cognitive impairment, non-English speaker, HF type, aetiology of cardiomyopathy, recent HF hospitalisation/need for IV diuretics & disease burden measured by NYHA Classification, NTproBNP & No. of comorbid conditions). Results In the 36 months studied there were 460 non-attenders (DNA rate 7.9%) out of 5,823 appointments. The DNA rate did not differ based on day of appointment (p=0.091)/ between the first & second halves of the year (p=0.059). 138 DNA's were compared with 138 controls who attended the same HF service over a 12-month period in 2021. Mean LVEF was similar between index (35.2%) &control cases (35.2%), NTproBNP did not differ significantly (2306 vs 2365) & no. of comborbid conditions did not differ significantly between groups (7 +/- 2.7 vs 6.8 +/-2.6). DNA's had a higher NYHA class than attenders (p=0.02). Measures of disease burden-recent HF hospitalisation/need for IV diuretics, NTproBNP & no. of comorbid conditions did not show statistical difference between index &control groups. There was a trend towards non-English-speaking patients & new referrals not attending appointments compared to the control group, however this did not reach statistical significance (p=0.06). Comparison of other variables such as gender, history of cognitive impairment/dementia, HF type, aetiology of cardiomyopathy did not influence attendance. (Table 1). Conclusion(s) Nonattendance to a HF management programme remained static annually with a mean DNA rate of 7.9% over the 3-year period studied. The present study did not identify any statistically significant clinical factors that influenced nonattendance, though there was a trend towards higher default rate for new patients & non-English speaking patients. NYHA class was higher in non-attenders than attenders though other indirect measures of disease burden did not influence attendance. Non clinical factors should be further studied to identify factors which influence nonattendance in order to develop strategies to minimise non-attendance