The Impact of a Dedicated Heart Failure (HF) Clinic on Hospitalization Rates, Hospitalization Costs, and Left Ventricular Ejection Fraction (LVEF) in Systolic Heart Failure Patients

Abstract

IntroductionHeart failure with reduced ejection fraction (HFrEF) is one of the most costly conditions with high morbidity and mortality. There is still paucity of data for cost-effective outpatient heart failure (HF) management. In an effort to prevent hospital admissions and morbidity, the focus has shifted toward effective outpatient care of these complex patients. Southwest Medical Associates Cardiology instituted a HF clinic in 2015, a collaboration of cardiologists with expertise in Advanced Heart Failure/Transplant, nurse practitioners, and nurse case managers. Each team member sees patients for routine medication uptitrations and as needed for hospital follow-ups. The team provides patients with extensive education regarding disease management, reinforces compliance, and closely monitors clinical status.HypothesisThe authors sought to determine the impact of a dedicated HF clinic on hospitalization rates, hospitalization costs, and left ventricular ejection fraction (LVEF). The authors wanted to determine if goals of guideline directed medical therapy (GDMT) optimization were met.MethodsData was collected on a cohort of 412 HFrEF patients who have been enrolled in the program for at least six months since 2016. Comparisons were made between six months before enrollment and six months after.ResultsHospitalization rates dropped from 0.61% to 0.29% (p=<.00001). Hospitalization costs decreased from $1035 to $828 (p=0.177). Average LVEF increased from 28% to 37% (p=.00001).Average lisinopril and losartan doses were unchanged. Lisinopril usage increased from 24.9% to 35.6% (p=.00084). Losartan usage increased from 6.1% to 19.2% (p=<.00001). Average carvedilol dose increased from 13 mg to 17 mg BID (p=0.001362). Metoprolol succinate dose increased from 50 mg to 108 mg daily. (p=0.000118). Carvedilol use increased from 11% to 46.2% (p=<.00001). Metoprolol use increased from 3.4% to 20.6% (p=< .00001). Spironolactone use increased from 15.7% to 29.2% (p=0.01208).ConclusionsHaving a dedicated HF clinic led to significant reductions in HF hospitalizations and cost and a modest increase in average LVEF in 412 patients after six months. Usage of ACEis, ARBS, BBs, and spironolactone showed statistically significant increases after enrollment. Future studies may be undertaken to determine the impact of extending the clinic enrollment for more than 6 months with emphasis on hospitalization rates, changes in BNP, LVEF improvement, and cost, as well as increased dosing/utilization of GDMT. Heart failure with reduced ejection fraction (HFrEF) is one of the most costly conditions with high morbidity and mortality. There is still paucity of data for cost-effective outpatient heart failure (HF) management. In an effort to prevent hospital admissions and morbidity, the focus has shifted toward effective outpatient care of these complex patients. Southwest Medical Associates Cardiology instituted a HF clinic in 2015, a collaboration of cardiologists with expertise in Advanced Heart Failure/Transplant, nurse practitioners, and nurse case managers. Each team member sees patients for routine medication uptitrations and as needed for hospital follow-ups. The team provides patients with extensive education regarding disease management, reinforces compliance, and closely monitors clinical status. The authors sought to determine the impact of a dedicated HF clinic on hospitalization rates, hospitalization costs, and left ventricular ejection fraction (LVEF). The authors wanted to determine if goals of guideline directed medical therapy (GDMT) optimization were met. Data was collected on a cohort of 412 HFrEF patients who have been enrolled in the program for at least six months since 2016. Comparisons were made between six months before enrollment and six months after. Hospitalization rates dropped from 0.61% to 0.29% (p=<.00001). Hospitalization costs decreased from $1035 to $828 (p=0.177). Average LVEF increased from 28% to 37% (p=.00001). Average lisinopril and losartan doses were unchanged. Lisinopril usage increased from 24.9% to 35.6% (p=.00084). Losartan usage increased from 6.1% to 19.2% (p=<.00001). Average carvedilol dose increased from 13 mg to 17 mg BID (p=0.001362). Metoprolol succinate dose increased from 50 mg to 108 mg daily. (p=0.000118). Carvedilol use increased from 11% to 46.2% (p=<.00001). Metoprolol use increased from 3.4% to 20.6% (p=< .00001). Spironolactone use increased from 15.7% to 29.2% (p=0.01208). Having a dedicated HF clinic led to significant reductions in HF hospitalizations and cost and a modest increase in average LVEF in 412 patients after six months. Usage of ACEis, ARBS, BBs, and spironolactone showed statistically significant increases after enrollment. Future studies may be undertaken to determine the impact of extending the clinic enrollment for more than 6 months with emphasis on hospitalization rates, changes in BNP, LVEF improvement, and cost, as well as increased dosing/utilization of GDMT.