Omar Wahbi Izzettin
Department of General Medicine, Alfred Hospital, Melbourne, Victoria

 ABSTRACT

Improving Acute Heart Failure Management in General Medical Inpatients: Implementation of 5+5 Heart Failure Care Program (HFCP)
Omar Wahbi Izzettin1*, Thomas Martin1, Kellie Easton,1 Edward Ritchie1, Vathy Nagalingam1, Ingrid Hopper1,2, Ar Kar Aung1,2
1Department of General Medicine, Alfred Hospital, Melbourne, Victoria
2School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria

Aims: To examine if implementation of multi-disciplinary heart failure care program (5+5 HFCP), which focuses on 5 key management aspects across 5 medical and allied health disciplines, improves the delivery of acute in-hospital heart failure care, patient education and self-management, and readmission rates in general medical patients. 

Methods: A single-centre prospective non-randomised study comparing the outcomes before and after care program implementation is conducted. In pre-implementation phase, pharmacologic and non-pharmacologic management outcomes were analysed in all patients admitted with acute heart failure to General Medical Unit over an 8-week period (March – April 2016).

Results: A total of 52 patients were admitted with acute heart failure in the pre-implementation period [mean age 82 ± 9.9 years, 29 (58%) females]. Most (45, 86%) were from home, many (42, 81%) had a baseline NYHA class I or II symptoms and 31 (60%) had heart failure with preserved ejection fraction. At discharge, 28 (54%) patients were on beta blockers, 35 (67%) on angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), 47 (90%) on frusemide, 10 (19%) on spironolactone and 13 (25%) on digoxin. Regarding inpatient non-pharmacologic management, 44 (85%) had daily weights, 49 (94%) had daily fluid balance charts and 45 (86%) had daily renal function and electrolyte measures. However, orthostatic blood pressure checks and salt restrictions were infrequently conducted (6% for both). At discharge, patient education on fluid restriction, weight monitoring and action plans were also infrequently provided (11%, 9% and 4% respectively). Only 1 (2%) was referred to heart failure nurse.

Conclusion: This pre-implementation study identified deficiencies in certain areas of acute inpatient heart failure management, such as non-pharmacologic management and patient education, which require urgent attention. Implementation of 5+5 HFCP will continue to strongly focus on these key areas. Performance improvement analysis at post-implementation phase will be presented at IMSANZ meeting.