Abstract 9240: Successful Implementation of ACCF/AHA Performance Measures for Adults With Heart Failure Reduces Mortality in South-East Asian Patients With Chronic Heart Failure

Abstract

Background: Heart failure (HF) is a leading cause of hospitalization in Singapore (5541 discharges in Financial Year 2012/2013). The National Healthcare Group comprises 3 public hospitals with a total bed complement of about 2950 and receives 50% of HF admissions in the nation. We evaluated the recent outcomes of our 10-year Heart Failure Disease Management Program (HFDMP). Methods: Patients admitted with a clinical diagnosis of acute HF were recruited from Apr 2007 to Mar 2012. All patients were managed by cardiologists. A clinical carepath was used to standardize evidence-based care. Prognostically beneficial drugs such as Angiotensin-Converting Enzyme-Inhibitors and Beta-Blockers were commenced inpatient at low doses and up-titrated as tolerated in the outpatient HF clinic. Case Managers educate and counsel patients on managing their disease, and provide telephone follow-up. Performance measures were tracked as per ACCF/AHA Guidelines. Results: We recruited 2900 patients, of whom 2527 remained in the HFDMP for at least one year. Of these, 62.9% were male, age 67.6 ± 13.2 (range 17-103) years, and mean LVEF 31.4 ± 14.5%. Median baseline 6 minute walk test (6MWT) was 250.5m, Minnesota Living With Heart Failure Questionnaire (MLWHF) score 33.5, and NYHA Class 2. At 6 months, median 6MWT improved to 281.1m, MLWHF score fell to 25, and NYHA Class was 1.76 (all p < 0.005). The 1-year mortality rate improved from 16.75% in 2007 to 11.46% in 2011 (Fig 1)despite stable readmission rates at 1, 6, and 12 months (Fig 2). Conclusion: HF treatment based on ACCF/AHA Performance Measures and implemented by a HFDMP results in real-world reduction in mortality without compromising on readmission rates.