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Optimizing heart failure management: An Australian experience
International Journal of Cardiology 112 (2006) 256 www.elsevier.com/locate/ijcard
Letters to the Editor
Optimizing heart failure management: An Australian experience Peter Barlis a,b,*, Richard MacIsaac a, David L. Hare b, Louise M. Burrell a,c a
c
Austin Health, General Medicine, Heidelberg, Victoria, Australia b Austin Health, Cardiology, Heidelberg, Victoria, Australia University of Melbourne, Medicine, Heidelberg, Victoria, Australia Received 5 July 2005; accepted 24 July 2005 Available online 2 November 2005
To the Editor It is known that in Australia, heart failure (HF) accounts for 9.5% of all hospitalizations for cardiovascular conditions, and has an average length of stay of 9.1 days [1]. Our previous work indicates that adherence to HF clinical practice guidelines is poor [2]. We present the strategy introduced in 2002, which is now the mainstay of management and follow-up of patients with HF in our institution. The program targets hospital medical officers (HMOs), nurses, pharmacists and allied health staff to enhance their understanding of practice guidelines [3]. Individual patient education is provided, with an interpreter if required, during the inpatient period followed by monitoring in the community and in a HF specific clinic. HMOs attend regular compulsory interactive seminars on the management of HF. Nurses are provided with regular inservice sessions and pharmacists and allied health staff are consulted in a weekly meeting ensuring optimal patient management. A heart failure clinical nurse, specialist registrar, cardiologist and/or general physician with an interest in heart failure provide the education. During the initial 3-month period, 65 patients admitted with HF to general medical units were assessed. This group was compared to 72 patients admitted in the 3-month period prior. The average age of patients was 78 years and 57% were male. 51 of 65 (78.5%) were followed up in the heart failure discharge clinic within 2 weeks of discharge. Daily weighing before and after implementation of the program was 33.3% vs. 70.6% ( p = 0.0002), fluid restriction 41.2%
* Corresponding author. E-mail address: [email protected] (P. Barlis). 0167-5273/$ - see front matter D 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2005.07.057
vs. 70.6% ( p = 0.03), ACE inhibition 72.5% vs. 80.4% ( p = 0.35), beta-blockade 23.6% vs. 45.1% ( p = 0.02). There was significant improvement in patient morbidity based on New York Heart Association Class assessed by a Cardiologist or Specialist Registrar. On admission, 7.8% of patients were Class 4, 62.7% Class 3 and 29.4% Class 2; at review 68.6% were Class 2 and 31.4% Class 1. In addition, 8% were on angiotensin II receptor blockers and 27.5% spironolactone (compared with 11.2% prior, p = 0.002). Our study is limited by its lack of randomization and blinding of data however it has been instrumental in improving the quality of care of patients with heart failure at our institution. A multidisciplinary approach to the management of heart failure, and adherence to clinical practice guidelines [3] has led to improvements in patient well-being and the practice of evidence based medicine in a clinically controlled and monitored setting.
References [1] Australian Institute of Health and Welfare. Heart, stroke and vascular diseases, Australian facts. Canberra’ AIHW and Heart Foundation of Australia; 2004 AIHW Cat. No. CVD-27; Cardiovascular Disease Series No.22. [2] Ryan R, Harding D, Burrell LM. Practice patterns after implementation of a clinical pathway for heat failure. Abstracts of the 24th Annual Scientific Meeting of the High Blood Pressure Research Council of Australia. Clin Exp Pharmacol Physiol 2003;30(7): A31 – 68. [3] Krum H. Guidelines for management of patients with chronic heart failure in Australia. Med J Aust 2001;174:459 – 66.
Letters to the Editor
Optimizing heart failure management: An Australian experience Peter Barlis a,b,*, Richard MacIsaac a, David L. Hare b, Louise M. Burrell a,c a
c
Austin Health, General Medicine, Heidelberg, Victoria, Australia b Austin Health, Cardiology, Heidelberg, Victoria, Australia University of Melbourne, Medicine, Heidelberg, Victoria, Australia Received 5 July 2005; accepted 24 July 2005 Available online 2 November 2005
To the Editor It is known that in Australia, heart failure (HF) accounts for 9.5% of all hospitalizations for cardiovascular conditions, and has an average length of stay of 9.1 days [1]. Our previous work indicates that adherence to HF clinical practice guidelines is poor [2]. We present the strategy introduced in 2002, which is now the mainstay of management and follow-up of patients with HF in our institution. The program targets hospital medical officers (HMOs), nurses, pharmacists and allied health staff to enhance their understanding of practice guidelines [3]. Individual patient education is provided, with an interpreter if required, during the inpatient period followed by monitoring in the community and in a HF specific clinic. HMOs attend regular compulsory interactive seminars on the management of HF. Nurses are provided with regular inservice sessions and pharmacists and allied health staff are consulted in a weekly meeting ensuring optimal patient management. A heart failure clinical nurse, specialist registrar, cardiologist and/or general physician with an interest in heart failure provide the education. During the initial 3-month period, 65 patients admitted with HF to general medical units were assessed. This group was compared to 72 patients admitted in the 3-month period prior. The average age of patients was 78 years and 57% were male. 51 of 65 (78.5%) were followed up in the heart failure discharge clinic within 2 weeks of discharge. Daily weighing before and after implementation of the program was 33.3% vs. 70.6% ( p = 0.0002), fluid restriction 41.2%
* Corresponding author. E-mail address: [email protected] (P. Barlis). 0167-5273/$ - see front matter D 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2005.07.057
vs. 70.6% ( p = 0.03), ACE inhibition 72.5% vs. 80.4% ( p = 0.35), beta-blockade 23.6% vs. 45.1% ( p = 0.02). There was significant improvement in patient morbidity based on New York Heart Association Class assessed by a Cardiologist or Specialist Registrar. On admission, 7.8% of patients were Class 4, 62.7% Class 3 and 29.4% Class 2; at review 68.6% were Class 2 and 31.4% Class 1. In addition, 8% were on angiotensin II receptor blockers and 27.5% spironolactone (compared with 11.2% prior, p = 0.002). Our study is limited by its lack of randomization and blinding of data however it has been instrumental in improving the quality of care of patients with heart failure at our institution. A multidisciplinary approach to the management of heart failure, and adherence to clinical practice guidelines [3] has led to improvements in patient well-being and the practice of evidence based medicine in a clinically controlled and monitored setting.
References [1] Australian Institute of Health and Welfare. Heart, stroke and vascular diseases, Australian facts. Canberra’ AIHW and Heart Foundation of Australia; 2004 AIHW Cat. No. CVD-27; Cardiovascular Disease Series No.22. [2] Ryan R, Harding D, Burrell LM. Practice patterns after implementation of a clinical pathway for heat failure. Abstracts of the 24th Annual Scientific Meeting of the High Blood Pressure Research Council of Australia. Clin Exp Pharmacol Physiol 2003;30(7): A31 – 68. [3] Krum H. Guidelines for management of patients with chronic heart failure in Australia. Med J Aust 2001;174:459 – 66.