Optimize Heart Failure Care Research Articles

Heart failure care in the Central and Eastern Europe and Baltic region: status, barriers, and routes to improvement.

Despite improvements over recent years, morbidity and mortality associated with heart failure (HF) are higher in countries in the Central and Eastern Europe and Baltic region than in Western Europe. With the goal of improving the standard of HF care and patient outcomes in the Central and Eastern Europe and Baltic region, this review aimed to identify the main barriers to optimal HF care and potential areas for improvement. This information was used to suggest methods to improve HF management and decrease the burden of HF in the region that can be implemented at the national and regional levels. We performed a literature search to collect information about HF epidemiology in 11 countries in the region (Bulgaria, Croatia, Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Serbia, and Slovenia). The prevalence of HF in the region was 1.6-4.7%, and incidence was 3.1-6.0 per 1000person-years. Owing to the scarcity of published data on HF management in these countries, we also collected insights on local HF care and management practices via two surveys of 11 HF experts representing the 11 countries. Based on the combined results of the literature review and surveys, we created national HF care and management profiles for each country and developed a common patient pathway for HF for the region. We identified five main barriers to optimal HF care: (i) lack of epidemiological data, (ii) low awareness of HF, (iii) lack of national HF strategies, (iv) infrastructure and system gaps, and (v) poor access to novel HF treatments. To overcome these barriers, we propose the following routes to improvement: (i) establish regional and national prospective HF registries for the systematic collection of epidemiological data; (ii) establish education campaigns for the public, patients, caregivers, and healthcare professionals; (iii) establish formal HF strategies to set clear and measurable policy goals and support budget planning; (iv) improve access to quality-of-care centres, multidisciplinary care teams, diagnostic tests, and telemedicine/telemonitoring; and (v) establish national treatment monitoring programmes to develop policies that ensure that adequate proportions of healthcare budgets are reserved for novel therapies. These routes to improvement represent a first step towards improving outcomes in patients with HF in the Central and Eastern Europe and Baltic region by decreasing disparities in HF care within the region and between the region and Western Europe.

Quality improvement collaborative to optimize heart failure care inpatients from a network ofclinics inArgentina during the COVID-19 pandemic.

Heart failure (HF) is a major clinical and public health problem associated with significant mortality, morbidity, and health-care costs. Despite the existence of evidence-based guidelines for the optimal treatment of HF, the quality of care remains suboptimal. Our aim was to increase the use a care bundle in 50% of enrolled subjects during their hospitalization and discharge and to reduce their readmission for HF causes by 10%. We conducted an uncontrolled before-after study in eight hospitals in Argentina to evaluate the effect of a quality improvement intervention on the use of an HF care bundle in patients with HF New York Heart Association (NYHA) Class II-III. The HF bundle of care included medication, continuum of care, lifestyle habits, and predischarge examinations. Training and follow-up of multidisciplinary teams in each center were performed through learning sessions and plan-do-study-act improvement cycles. Data collectors reviewed bundle compliance in the health records of recruited patients after their hospital discharge and verified readmissions through phone calls to patients within 30-40 days after discharge. We recruited 200 patients (83 before and 127 during the intervention phase), and bundle compliance increased from 9.6% to 28.3% [odds ratio 3.71, 95% confidence interval (8.46; 1.63); P = .002]. Despite a slow improvement during the first months, bundle compliance gained momentum near the end of the intervention surpassing 80%. We observed a non-significant decreased readmission rate within 30 days of discharge due to HF in the postintervention period [8.4% vs. 5.5%, odds ratio 0.63, 95% CI (1.88; 0.21); P = .410]. Qualitative analysis showed that members of the intervention teams acknowledged the improvement of work organization and standardization of care, teamwork, shared mental model, and health record completeness as well as the utility of training fellows. Despite the challenges related to the pandemic, better care of patients with HF NYHA Class II-III was possible through simple interventions and collaborative work. Graphical abstract.

Management of Heart Failure Care In Rural West Virginia: A Primary Care Perspective

Introduction Geographically dispersed patient populations, provider shortages, and deficits in ancillary services makes optimal heart failure care challenging for patients residing in rural communities. Providing effective care to this complex patient population requires significant knowledge, as well as ample time and availability of complementary, ancillary services. We developed a survey for heart failure care providers in rural West Virginia to self report knowledge of guideline directed care and to evaluate access and use of resources necessary for optimal heart failure management. Methods The 2019 West Virginia Practice-Based Research Network (WVPBRN) Collective Outreach and Research Engagement (CORE) Survey was uploaded to REDCap and distributed to healthcare providers in the Network via email, social media postings, and newsletter announcements. Out of Network non-members in West Virginia (WV) were also encouraged to respond. Survey responses were anonymous and later analyzed by the WV Clinical and Translational Science Institute. Results A total of 41 primary care providers (71% physicians and 29% CRNP, PA, or RN) anonymously responded to the survey. While the majority of respondents practice in rural WV counties, 85% practiced within 10 miles of a hospital. Despite this finding, a great majority of respondents were the main provider of heart failure care, with 76% regularly starting or adjusting heart failure medications. Only 21% of providers stated that their patients had echocardiogram performed in a cardiologist office with the remainder being performed at the local hospital. With respect to knowledge of GDMT, 22% felt they had excellent knowledge, 76% had average knowledge and 2% had poor knowledge. Time spent caring for patients was 20 minutes or less by 76% of providers and 63% of them felt that they needed more time to provide the care required of these patients. With respect to access to multidisciplinary care, most providers 71% had adequate access to a pharmacist, but only 27% had access to a dietician. Conclusions Primary care providers appear to provide the majority of care for patients with heart failure in the rural community irregardless of proximity to a hospital. Opportunity exists to increase knowledge in these providers and to provide better access to ancillary services such a as pharmacists and dietitians which could alleviate the perception that more time is required to provide quality care in rural WV.

Optimizing Access to Heart Failure Care in Canada During the COVID-19 Pandemic

The traditional model of heart failure (HF) care in Canada, which relies upon a multidisciplinary team and clinic-based care processes, has been undermined as a result of the COVID-19 pandemic. As the pandemic continues, we will be challenged to improve or maintain the health status of those with HF by optimizing guideline-directed care despite physical distancing constraints and a reduction in the health care workforce. This will require development of new strategies specifically targeted at decreasing the risk of decompensation and resultant HF hospitalization. As such, we must quickly pivot to the adoption and application of novel technologies and revise usual care models, processes, and workflow. The unprecedented COVID-19 crisis has delivered the Canadian HF community a burning platform for the design and implementation of innovative approaches to support the vulnerable population we serve; born out of necessity, we now have the opportunity to explore innovative approaches that might inform the future of HF care delivery in Canada. Herein, we provide perspectives from leadership within the Canadian Heart Failure Society on how to optimize HF care during the COVID-19 pandemic.

P6335The impact of patient's adherence to maintenance of euvolaemia on all-cause mortality and heart failure re-hospitalization: insights from the Optimize Heart Failure Care Program

Abstract Background Four recommended self-care behaviors (low salt diet, avoidance of excessive fluid intake, weight control, and flexible diuretic regimen) play an important role in the management of heart failure (HF) patients. However, little is known about the impact of patients' adherence to these self-care behaviors on prognosis and rate of HF re-hospitalizations. The aim of our study was to analyze the impact of HF patients' adherence to maintenance of euvolaemia on all-cause mortality and HF re-hospitalizations. Methods The analysis included data from the international prospective multicenter Optimize Heart Failure Care Program which was collected over 12 months from 628 patients (mean age 62.6±12.3 years, 70% male) hospitalized with decompensated HF, NYHA II-IV (mean 2.7±0.6), mean left ventricular ejection fraction 33.8±9.4%. The underlying etiology of HF was ischemic in 64% of cases. Before discharge from the hospital all HF patients were educated in self-care skills to maintain the euvolaemia. To assess patients' adherence to low salt diet, avoidance of excessive fluid intake, weight control and flexible diuretic regimen, an indirect method (patient-reported compliance, which was measured using a special questionnaire) was used. Three types of adherence were determined: good (patients always maintained euvolaemia), moderate (patients sometimes maintained euvolaemia) and poor adherence (patients did not maintain euvolaemia). Results After discharge from the hospital the overall adherence rates were 66.4% for low sodium diet, 58% for fluid intake, 69.9% for weight control, and 87.2% for the flexible diuretic regimen. However, the adherence to diet and the flexible diuretic regimen significantly decreased (p<0.01) by the 12 months of follow-up. Good, moderate and poor adherence to maintain euvolaemia were noted in 40%, 31.5% and 28.5% patients, respectively. After 12 months of follow-up all-cause mortality and rate of HF re-hospitalizations and were significantly lower in the group of good patients' adherence in comparison with moderate and poor patients' adherence (HR 0.72, 95% CI 0.61–0.84, p<0.0001) (Figure). Conclusion Less than half of HF patients demonstrated good adherence to the guideline-recommended control of euvolaemia. The rates of all-cause mortality and HF re-hospitalizations in the group of good patient's adherence were significantly lower compared with the groups of moderate and poor adherence to maintenance of euvolaemia. Constant efforts to promote the maintenance of euvolaemia in HF patients are needed.

Facilitators and barriers of heart failure care in Kerala, India: A qualitative analysis of health-care providers and administrators

ObjectiveHeart failure is a leading cause of death worldwide and in India, yet the qualitative data regarding heart failure care are limited. To fill this gap, we studied the facilitators and barriers of heart failure care in Kerala, India. Methods and resultsDuring January 2018, we conducted a qualitative study using in-depth, semi-structured interviews with 21 health-care providers and quality administrators from 8 hospitals in Kerala to understand the context, facilitators, and barriers of heart failure care. We developed a theoretical framework using iteratively developed codes from these data to identify 6 key themes of heart failure care in Kerala: (1) need for comprehensive patient and family education on heart failure; (2) gaps between guideline-directed clinical care for heart failure and clinical practice; (3) national hospital accreditation contributing to a culture of systematically improving quality and safety of in-hospital care; (4) limited system-level attention toward improving heart failure care compared with other cardiovascular conditions; (5) application of existing personnel and technology to improve heart failure care; and (6) longitudinal and recurrent costs as barriers for optimal heart failure care. ConclusionsKey themes emerged regarding heart failure care in Kerala in the context of a health system that is increasingly emphasizing health-care quality and safety. Targeted in-hospital quality improvement interventions for heart failure should account for these themes to improve cardiovascular outcomes in the region.

Effect of the Optimize Heart Failure Care Program on clinical and patient outcomes – The pilot implementation in Vietnam

BackgroundThe Ho-Chi-Minh-city Heart Institute in Vietnam took part in the Optimize Heart Failure (OHF) Care Program, designed to improve outcomes following heart failure (HF) hospitalization by increasing patient awareness and optimizing HF treatment. MethodsHF patients hospitalized with left ventricular ejection-fraction (LVEF) <50% were included. Patients received guideline-recommended HF treatment and education. Clinical signs, treatments and outcomes were assessed at admission, discharge, 2 and 6 months (M2, M6). Patients' knowledge and practice were assessed at M6 by telephone survey. Results257 patients were included. Between admission and M2 and M6, heart rate decreased significantly, and clinical symptoms improved significantly. LVEF increased significantly from admission to M6. 85% to 99% of patients received education. At M6, 45% to 78% of patients acquired knowledge and adhered to practice regarding diet, exercise, weight control, and detection of worsening symptoms. High use of renin-angiotensin-aldosterone-system inhibitors (91%), mineralocorticoid-receptor-antagonists (77%) and diuretics (85%) was noted at discharge. Beta-blocker and ivabradine use was less frequent at discharge but increased significantly at M6 (from 33% to 51% and from 9% to 20%, respectively, p < 0.001). There were no in-hospital deaths. Readmission rates at 30 and 60 days after discharge were 8.3% and 12.5%, respectively. Mortality rates at 30 days, 60 days and 6 months were 1.2%, 2.5% and 6.4%, respectively. ConclusionsThe OHF Care Program could be implemented in Vietnam without difficulty and was associated with high usage of guideline-recommended drug therapy. Although education was delivered, patient knowledge and practice could be further improved at M6 after discharge.

208Physicians and patients adherence to guidelines is associated with better prognosis in patients with heart failure: insights from the Optimize Heart Failure Care Program

208Physicians and patients adherence to guidelines is associated with better prognosis in patients with heart failure: insights from the Optimize Heart Failure Care Program

The need for dedicated advanced heart failure units to optimize heart failure care: impact of optimized advanced heart failure unit care on heart transplant outcome in high-risk patients.

AimWith an increasing prevalence of heart failure (HF), more patients with advanced disease have to be treated in cardiology units by sophisticated medical and interventional strategies. We therefore developed a dedicated advanced heart failure unit (AHFU) to target the specific needs of the many patients with advanced HF. We here present our concept and its impact on outcome in high‐risk high‐urgency (HU) heart transplant candidates.Methods and resultsThe eight‐bed unit was established as an extension of the cardiologic intensive care and coronary care units in an intermediate care setting. Each bed was equipped with 24 h haemodynamic, respiratory, and arrhythmia monitoring. The unit is served 24/7 by five residents in cardiology, one staff cardiologist specializing in medical and interventional HF care, and 10 intensive care nurses. The cardiology team is supported by colleagues from cardiac surgery, sports medicine, psychosomatics, and the internal medicine departments. As an example of the intensified care on the AHFU, data from the cohorts of patients undergoing heart transplantation from HU status before (pre‐AHFU 2008–11) and after establishment of the AHFU (AHFU 2012–15) were analysed. Interestingly, mortality on HU waiting list and post‐heart transplant survival was comparable in both cohorts, despite significant increase in morbidity and co‐morbidity as assessed by the Index for Mortality Prediction After Cardiac Transplantation model in the AHFU group.ConclusionsOur AHFU provides a unique and novel setting for the integration of modern pharmacological, interventional, surgical, and supportive HF therapy embedded in an academic heart centre. This may be a major step forward in the care of critical patients with advanced HF.

Optimization of heart rate lowering therapy in hospitalized patients with heart failure: Insights from the Optimize Heart Failure Care Program

BackgroundHospitalization is an opportunity to optimize heart failure (HF) therapy. As optimal treatment for hospitalized HF patients in sinus rhythm with heart rate≥70bpm is unclear, we investigated the impact of combined beta-blocker (BB) and ivabradine versus BBs alone on short and longer term mortality and rehospitalization. Methods and resultsA retrospective analysis was performed on 370 hospitalized HF patients with heart rate≥70bpm (150 BB+ivabradine, 220 BB alone) in the Optimize Heart Failure Care Program in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Russia, Ukraine, and Uzbekistan, from October 2015 to April 2016. ResultsAt 1month, 3months, 6months and 12months, there were fewer deaths, HF hospitalizations and overall hospitalizations in patients on BB+ivabradine vs BBs alone. At 12months, all-cause mortality or HF hospitalization was significantly lower with BB+ivabradine than BBs (adjusted hazard ratio [HR] 0.45 (95% confidence interval [CI] 0.32–0.64, P<0.0001). Significantly greater improvement was seen in quality of life (QOL) from admission to 12months with BB+ivabradine vs BBs alone (P=0.0001). With BB+ivabradine, significantly more patients achieved ≥50% target doses of BBs at 12months than on admission (82.0% vs 66.6%, P=0.0001), but the effect was non-significant with BBs alone. ConclusionsHeart rate lowering therapy with BB+ivabradine started in hospitalized HF patients (heart rate≥70bpm) is associated with reduced overall mortality and re-hospitalization over the subsequent 12months. A prospective randomized trial is needed to confirm the advantages of this strategy.

The Optimize Heart Failure Care Program: Initial lessons from global implementation

Hospitalization for heart failure (HF) places a major burden on healthcare services worldwide, and is a strong predictor of increased mortality especially in the first three months after discharge. Though undesirable, hospitalization is an opportunity to optimize HF therapy and advise clinicians and patients about the importance of continued adherence to HF medication and regular monitoring.The Optimize Heart Failure Care Program (www.optimize-hf.com), which has been implemented in 45 countries, is designed to improve outcomes following HF hospitalization through inexpensive initiatives to improve prescription of appropriate drug therapies, patient education and engagement, and post-discharge planning. It includes best practice clinical protocols for local adaptation, pre- and post-discharge checklists, and ‘My HF Passport’, a printed and smart phone application to improve patient understanding of HF and encourage involvement in care and treatment adherence.Early experience of the Program suggests that factors leading to successful implementation include support from HF specialists or ‘local leaders’, regular educational meetings for participating healthcare professionals, multidisciplinary collaboration, and full integration of pre- and post-hospital discharge checklists across care services. The Program is helping to raise awareness of HF and generate useful data on current practice. It is showing how good evidence-based care can be achieved through the use of simple clinician and patient-focused tools. Preliminary results suggest that optimization of HF pharmacological therapy is achievable through the Program, with little new investment. Further data collection will lead to a greater understanding of the impact of the Program on HF care and key indicators of success.

Towards Optimal Heart Failure Care: Couples-Oriented Strategies to Improve Patient Adherence and Health Outcomes.

Psychosocial factors play an important role in the development and progression of cardiovascular diseases (CVD), such as chronic heart failure (CHF). In particular, psycho-cognitive disturbance is common in CHF, which presents additional challenges to secondary prevention and management strategies. This review provides a summary of the contemporary psycho-cardiology literature, including coverage of common mood and cognitive symptoms, and explores some of the pathophysiologic evidence linking psycho-cognition to CHF, with particular emphasis on sympathetic nervous system activation and neuroendocrine functioning. Social support is identified as a strategy by which to reduce depressive symptoms, manage cognitive impairment and to, potentially, improve health outcomes through improved patient self care and adherence. Recent research outcomes suggest that the integration of family caregivers into CHF psycho-educational disease management programs, as providers and recipients of support, may achieve best outcomes. In this regard, couples-oriented strategies that promote communication, emotional attachment and support may enhance health-promoting behaviours in patients and their partners.

49 The Annual Global Economic Burden of Heart Failure

BackgroundAs the global problem of heart failure (HF) increases, there is also the significant economic burden of disease to be considered. It is vital for authorities to have an estimate...

Components of heart failure management in home care; a literature review

Patients with heart failure (HF) need long-term and complex care delivered by healthcare professionals in primary and secondary care. Although guidelines on optimal HF care exist, no specific description of components that are applied for optimal HF care at home exist. The objective of this review was to describe which components of HF (home) care are found in research studies addressing homecare interventions in the HF population. The Pubmed, Embase, Cinahl, and Cochrane databases were searched using HF-, homecare services-, and clinical trial-related search terms. The literature search identified 703 potentially relevant publications, out of which 70 articles were included. All articles described interventions with two or more of the following components: multidisciplinary team, continuity of care and care plans, optimized treatment according to guidelines, educational and counselling of patients and caregivers, and increased accessibility to care. Most studies (n=65, 93%) tested interventions with three components or more and 20 studies (29%) used interventions including all five components. There a several studies on HF care at home, testing interventions with a variety in number of components. Comparing the results to current standards, aspects such as collaboration between primary care and hospital care, titration of medication, and patient education can be improved.

NP010 A unit level toolkit to optimize heart failure care across different organizations

The prevalence of heart failure is increasing due to our aging population and improvement and diagnosis of myocardial infraction (Johanssen and Strauss, 2003).While heart failure guidelines and clinical pathways have been well published across North America and some of the European countries, there is still some practice variation in the adherence to these guidelines. (NHS Guideline, 2009) Initial research at a Canadian tertiary care centre indicated a 10-20% over the national average for in-hospital mortality for HF patients and 50% over the national average for readmission rates and a higher than the national average LOS. A pilot project to optimize care was initiated and completed on two medical cardiology units focusing on improving team communication, use of the order sets to reduce practice variation and patient education and follow up. Unit level involvement was sought and five key improvement areas were identified. These changes are now being disseminated hospital wide. This presentation will discussed and summarize a toolkit that was used successfully by frontline managers and educators in bringing out the change and improvement in clinical processes at the direct care provider level in order to prioritize and optimize heart failure care. This toolkit is being reviewed as a prototype for other centres wishing to optimize heart failure care.

Immunizations, Risk Factor Modification as Opportunities To Optimize Heart Failure Care

Immunizations, Risk Factor Modification as Opportunities To Optimize Heart Failure Care