P242 ADVANCED HEART FAILURE: ENHANCEMENT OF INTEGRATED MANAGEMENT IN THE METROPOLITAN AREA OF FORLÌ

Abstract

Abstract The aim of this study is to assess the effectiveness of a multi–professional home care (HC) model – cardiologist, general practitioner, cardiology nurse – which has been active in the metropolitan area of Forlì since 1999. In May 2021, 14 patients were enrolled (mean age=75.43). Inclusion criteria: heart failure (HF) in NYHA class III–IV, recurrent hospitalizations for HF and difficulties to reach the clinic. 4 out of 14 patients had been followed by the cardiologic HC program since 2016, 3 patients since 2018, 1 patient since 2019, 1 patient since 2020, 5 patients since 2021. Outcome Measures Rate of hospital admissions for HF 6 and 12 months before and after admission in HC pathway, quality of life (Minnesota Test), functional residual capacity (Palliative Performance Scale, PPS), compliance to the therapeutic program (Morisky Test). Questionnaires were administered when patients were included in HC and repeated at the time of enrollment and after 6 months. 3 patients were excluded from the analysis after enrollment because they died (n = 2) or were admitted in nursing homes (n = 1). It was observed that hospitalizations due to HF decreased from 1.64 during the 6 months preceding the admission in HC to 0.36 in the following 6 months (–78.05%, p = .002); furthermore, patients included in HC for more than 12 months (n = 9) decreased their hospitalizations from 1.78 in the year before their inclusion in the HC pathway to 0.33 in the year after (81.46%, p = .012). Since the cost of an average hospitalization for HF has been evaluated to be € 3,265.90 (DRG 127 Emilia–Romagna Region 2020), it was estimated a reduction in costs per patient of € 4,180.36 in 6 months and € 4,735.55 in 12 months. During the follow–up period, patients experienced a clinically significant improvement in psychophysical and social well–being and in the performance of daily activities. The mean Minnesota Test score improved (p = .001) from 62.86 (at the admission in HC) to 44.21 (at the enrollment) and 40.09 (at 6 months); the PPS score increased (p = .0021) from 56.43% (at the admission in HC) to 61.43% (at the enrollment) and 67.27% (at 6 months). Good therapeutic adherence was maintained, with a Morisky Test score ≥ 10. In conclusion, these preliminary results are consistent with recent ESC guidelines for the multi–professional care of patients with chronic HF and show the efficacy of this approach in order to prevent hospital admissions and to improve quality of life.