Impact of a Newly Established Multidisciplinary Heart Failure Clinic on Quality of Life of Low-To-Middle Income Patients in a Latin American Public Healthcare System.

Abstract

Background Heart Failure (HF) is a major public health problem associated to significant morbidity, mortality and cost. The management of HF patients involves interventions that vary widely in complexity, including left ventricular assist devices and transplantation. While multidisciplinary HF clinics (MDHFC) have been shown to reduce HF hospitalizations and mortality, little is known about the impact of MDHFC on quality of life (QoL) of HF patients in developing countries. We sought to evaluate the impact of our newly developed MDHFC on QoL of HF patients. Methods The MDHFC at Santo Tomas Hospital, a national public reference hospital located in Panama City, Panama, is the first MDHFC in the country and was first established in 2016. HF patients of this MDHFC are prospectively enrolled in a registry after providing informed consent. In the present study, we included patients with an LVEF≤ 40%, who were enrolled between 2016 and 2017. Enrolled patients receive intensive HF education, titration of medications, social work and nutrition services evaluation for the first three months. This is followed by a maintenance phase in which serial medical evaluations are performed. QoL was assessed at baseline and at 6 months by means of the Minnesota Living with HF Questionnaire (MLHFQ) and the New York Heart Association (NYHA) Functional Class Assessment. Results A total of 38 patients were enrolled in the study. Half of the patients had ischemic cardiomyopathy. Out of 38 patients, 28 patients completed a follow-up of at least 6 months (8 patients died prior to the 6-month assessment and 2 were lost to follow-up). Patients median age was 60 (IQR: 53, 66), 33% were females. In regards to QoL assessesment, there was a reduction in the MLHFQ score from 67 (IQR 38, 81) at baseline, to 21 (IQR 9, 37) at 6 months (p Figure ). Similarly, NYHA functional class improved at 6-month (NYHA I: 68.9%, NYHA II: 24.1%, NYHA II:6.9%) compared to baseline (NYHA I: 26.2%, NYHA II: 49.2%, NYHA II:24.6%)(p Conclusions A MDHFC is a feasible strategy to manage low-to-middle income HF patients in developing countries. Such comprehensive and structured approach seems to be associated to significant improvements in QoL among HF patients.