Introduction of anew scoring tool to identify clinically stable heart failure patients.

A J Gingele,C Knackstedt,J J J Boyne,L Brandts,G Cleuren,H P Brunner-La Rocca

doi:10.1007/s12471-021-01654-8

A J Gingele, C Knackstedt + Show 4 more

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https://doi.org/10.1007/s12471-021-01654-8

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Abstract

IntroductionHeart failure (HF) poses a burden on specialist care, making referral of clinically stable HF patients to primary care a desirable goal. However, a structured approach to guide patient referral is lacking.MethodsThe Maastricht Instability Score—Heart Failure (MIS-HF) questionnaire was developed to objectively stratify the clinical status of HF patients: patients with a low MIS-HF (0–2 points, indicating a stable clinical condition) were considered for treatment in primary care, whereas high scores (> 2 points) indicated the need for specialised care. The MIS-HF was evaluated in 637 consecutive HF patients presenting between 2015 and 2018 at Maastricht University Medical Centre.ResultsOf the 637 patients, 329 (52%) had a low score and 205 of these 329 (62%) patients were referred to primary care. The remaining 124 (38%) patients remained in secondary care. Of the 308 (48%) patients with a high score (> 2 points), 265 (86%) remained in secondary care and 41 (14%) were referred to primary care. The primary composite endpoint (mortality, cardiac hospital admissions) occurred more frequently in patients with a high compared to those with a low MIS-HF after 1 year of follow-up (29.2% vs 10.9%; odds ratio (OR) 3.36, 95% confidence interval (CI) 2.20–5.14). No significant difference in the composite endpoint (9.8% vs 12.9%; OR 0.73, 95% CI 0.36–1.47) was found between patients with a low MIS-HF treated in primary versus secondary care.ConclusionThe MIS-HF questionnaire may improve referral policies, as it helps to identify HF patients that can safely be referred to primary care.Supplementary InformationThe online version of this article (10.1007/s12471-021-01654-8) contains supplementary material, which is available to authorized users.

Highlights

Heart failure (HF) poses a burden on specialist care, making referral of clinically stable HF patients to primary care a desirable goal
The primary composite endpoint occurred more frequently in patients with a high compared to those with a low Maastricht Instability Score—Heart Failure (MIS-HF) after 1 year of follow-up (29.2% vs 10.9%; odds ratio (OR) 3.36, 95% confidence interval (CI) 2.20–5.14)
No significant difference in the composite endpoint (9.8% vs 12.9%; OR 0.73, 95% CI 0.36–1.47) was found between patients with a low MIS-HF treated in primary versus secondary care

Summary

Introduction

Heart failure (HF) poses a burden on specialist care, making referral of clinically stable HF patients to primary care a desirable goal. Health care consumption among HF patients is extensive, mainly due to frequent hospital admissions and outpatient clinic visits. Together, this poses a significant burden on HF specialists [2, 3], making a stronger involvement of primary care desirable. This poses a significant burden on HF specialists [2, 3], making a stronger involvement of primary care desirable It has been questioned whether primary care can meet the complex demands of HF patients [4]. Stable HF patients with mild symptoms may be safely referred to primary care, whereas patients with moderate to severe HF might need more targeted cardiovascular care by HF specialists [8]

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