Background:
Acute decompensated heart failure is a leading cause of hospitalizations in adults older than 65 years. While randomized trials have shown medical therapy to be effective in reducing heart failure hospitalisations, real-world data showing the effectiveness of their implementation and impact on readmissions is scarce. This study aimed to evaluate ACC/AHA directed discharge practices for patients with heart failure with reduced ejection fraction (HFrEF) at a community hospital and its effect on 30-day readmission rates.
Methods:
This was a retrospective analysis of 868 patients admitted to a community hospital with HFrEF. HFrEF was confirmed for patients based on their most recent Echocardiogram. Data collection points included age, comorbidities (HTN, DM, CKD) and ejection fraction on last Echo. There were 2 primary measured outcomes: medications at discharge and 30-day readmission rates for HFrEF. Discharge medications were subdivided into a combination of either {ACEI/ARB, Beta-blocker (BB) and Spironolactone} or {ACEI/ARB and BB} or {Nitrates/Hydralazine}-all combinations recognised as guideline directed medical therapy (GDMT); or BB alone or ACEI alone. Secondary outcomes included fluid and salt restriction recommendations on discharge and its effect on 30-day readmission rates.
Results:
After applying exclusion criteria, 320 patients admitted from 2016-2019 for HFrEF were assessed. Using descriptive analyses, it was found that 77% of patients (247/320) were appropriately discharged on GDMT including a combination of {ACEI/ARB, BB and Spironolactone (59/320)}, {ACEI/ARB and BB (173/320)} and {Nitrates/Hydralazine (15/320)}, respectively. The remaining 23% patients were discharged on ACEI or BB alone (73/320). Only 4.38% of patients discharged on ACEI/ARB, BB and Spironolactone were readmitted within 30 days. Similar results were seen across the ACEI/ARB and BB arm (9.38%) and the Nitrates/Hydralazine arm (1.88%). Readmission was significantly higher for patients discharged on a BB alone (27.78%) or ACEI alone (28.57%). Readmission rates for patients recommended fluid and salt restriction versus those who were not, were not statistically significant.
Conclusion:
While ACC/AHA guidelines in accordance with Target HF, recommend early initiation of GDMT in HFrEF, our study aimed to assess real world implementation of these guidelines at a community hospital. Our study found that while our readmission rates remained higher than the national average (21.9%) in patients discharged on ACEI or BB alone, in agreement with trials, readmission rates were significantly lower in patients discharged in each combination of GDMT. Our study highlights the importance of greater focus on providing high-value care with high compliance with GDMT to reduce readmissions and improve patient outcomes.
MORTALITY AND GUIDELINE DIRECTED MEDICAL THERAPY IN HEART FAILURE PATIENTS WITH REDUCED EJECTION FRACTION: EVIDENCE FROM REAL WORLD DATA
