Can the use of a structured management approach using ABCDEF mnemonic to manage multi-morbdiity in HFpEF improve clinical outcomes?

Abstract

Abstract Introduction Patients with heart failure with preserved ejection fraction (HFpEF) also have other co-morbidities which independently influence clinical outcomes as well as response to treatment. ESC guidelines recommend management of multimorbidity to improve clinical outcomes. The aim of this feasibility study was to test the use of a structured approach by HF specialist nurse using the prompt of an ABCDEF mnemonic to guide management of multimorbidity in HFpEF clinics and compare this with standard care (without prompt by a mnemonic). Methods This was a retrospective analysis of a prospective cohort study of 75 patients with recent decompensated HFpEF within 30 days, who were reviewed in a clinic by a HF specialist nurse. (38 patients in the "mnemonic" cohort and 37 patients in the standard care cohort). ABCDEF mnemonic was used to prompt the HF specialist nurse to address co-morbidities in the "mnemonic cohort" (A-Anaemia/Atrial fibrillation/sleep Apnoea, B- Blood pressure control, Body Mass Index, C- Chronic Kidney Disease and Chronic Obstructive Pulmonary disease, D- Diabetes control, E- Exercise rehab, F- Frailty assessment and need for advance care planning) whereas the HF nurse who assessed patients in standard care cohort followed standard national and international HFpEF guidelines for multimorbidity management (without the aid/prompt of a mnemonic). We also compared all-cause readmissions at 30 days and 3 months between the 2 cohorts. Statistical analysis was performed using Chi-squared test or Student’s T test as appropriate. Results The mean age was comparable between the 2 cohorts (mnemonic cohort -77.5±13.6, standard care 76.9±10.2 p=0.8) as was the proportion of female patients (mnemonic cohort 54% vs. standard care 46%; p=0.45). There was also no significant difference in terms of co-morbidities (mnemonic cohort 3.7±1.2 vs. std. care 3.6±1.1; p=0.7), frailty (mnemonic cohort 4.3±1.3; std. care 4.5±1.1; p=0.42), NTproBNP (Mnemonic cohort 1590 ng/L (368-11657(; std. care 1926 ng/L IQR- 389-10593; p=0.51). Investigations or interventions were performed to address co-morbidities in lower proportion of HFpEF patients in the standard care cohort (43%) compared to mnemonic cohort (100%; p<0.001). 30-day all-cause re-admissions showed a trend towards being lower in the mnemonic cohort (30 readmissions mnemonic 10% vs. std. care 22%; p=0.1); 3 month (mnemonic cohort 16%, std. care 35% p=0.05). Conclusions Use of a structured mnemonic approach to manage multimorbidity appears to be an easy tool to apply in HFpEF clinics, reflected by the high adherence rate and shows a trend towards lower 3-month all-cause readmissions. The results will need to be validated in a a larger randomised controlled trial with longer follow-up.