Acute Heart Failure Advanced Life Support: Guideline-Based Interactive Training for Providers

Abstract

Introduction There are over one million hospitalizations per year in the United States (US) for acute decompensated heart failure (ADHF). Unfortunately, there is often a delay in initiating guideline directed medical therapy (GDMT) and other interventions resulting in prolonged length of stay, increased readmission rate, and higher mortality. To date, no formal program has been established on education to streamline heart failure GDMT for US providers. Our center implemented Acute Heart Failure Advanced Life Support (AHFALS), a novel international educational training course to address this deficit. AHFALS, developed by Sociedade de Cardiologia do Estado de San Paulo, has been successfully implemented throughout Brazil and Portugal. This four hour course provides a standardized, algorithmic approach integrating current GDMT for management of ADHF utilizing interactive patient simulation with manikins similar to Advanced Cardiac Life (ACLS). The course teaches appropriate management across the continuum of care; from the emergency department to inpatient care with transition to outpatient care. Hypothesis Course participants will have improved knowledge of ADHF management, improvement in post-test course scores compared with pre-test course scores, and a high level of participant satisfaction upon course completion. Methods Participants received course materials via email and completed a pre-test online. Upon completion of a half-day course taught by trained instructors, the post-test was administered in written form and scored. A score of 70% or greater was considered passing, resulting in course certification. Participants were given a satisfaction survey, with a follow-up survey 6 months post-course completion. Results 115 internal medicine, emergency medicine, hospitalists, cardiology fellows, and advanced practice providers participated in the course and completed the pre/post-test and participant satisfaction survey. There was a statistically significant difference between pre (Avg 55.47%, STD 16.09) and post-test (Avg 73%, STD 11.21) exam scores with a p-value of Conclusions Preliminary data show high provider satisfaction, improvement in knowledge base and level of comfort in management of ADHF across the continuum of care. We anticipate more providers completing AHFALS within our institution and throughout local hospitals. Our hope is to expand the AHFALS course statewide and eventually nationwide and utilize it to train house staff, cardiology fellows and other providers managing ADHF. AHFALS will likely become recognized as an educational tool with credentialing similar to ACLS. Data collection is ongoing along with course expansion to determine the impact on patient outcomes.