Heart failure therapeutic units: Prognostic impact

Abstract

Introduction

Heart failure (HF) continues to be a prevalent condition with high morbidity and mortality despite numerous therapeutic advances. Thus, we created a Heart Failure Therapeutic Unit (HFTU) to optimize medical treatment promptly.

Objective

Primary objective: to study the impact of the HFTU on reducing cardiovascular mortality and heart failure rehospitalizations at 1 year. Secondary objectives: to study the impact of the HFTU on treatment dose optimization and patient therapeutic adherence.

Method

We conducted a prospective, longitudinal, and single-center study at our cardiology department, with a follow-up period of 1 year. We included 159 patients with chronic HF (108 were included in the HFTU group and 51 in the control group). Patients included in the HFTU group received more frequent follow-up, early initiation of medical treatment with rapid progression to optimal doses, and transition to second-line treatments if there was no improvement and if indicated. The control group received standard care.

Results

The average age was 62.5 ± 11.7 years, with a male predominance (80.5%), and a high prevalence of diabetes (44%); ischemic cardiomyopathy was the dominant etiology (57.9%), with a mean left ventricular ejection fraction (LVEF) of 31.6 ± 8%. The most common inclusion criterion in the HFTU group was the absence of optimal medical treatment (97.2%). We observed a significant reduction in cardiovascular mortality and HF rehospitalizations at 1 year, as well as a significant decrease in HF rehospitalizations at 1 year in the UTIC group compared to the control group (15.7% vs 41.2%; P < 0.001; 11.1% vs 35.3%; P < 0.001 respectively), regardless of age, gender, and comorbidities (P < 0.001). Acquisition of optimal medical treatment (P < 0.001) and therapeutic adherence (P = 0.015) were more frequent in the HFTU group. We noted an improvement in dyspnea (P = 0.003), in LVEF (from ≤ 40% to > 40%) (P < 0.001) and in heart rate control (HR < 70 bpm) (P < 0.001) in the HFTU group compared to the control group.

Conclusion

HFTU was associated with a significant reduction in the combined endpoint of cardiovascular mortality and heart failure rehospitalizations, as well as a decrease in heart failure rehospitalizations. Additionally, it was associated with more therapeutic optimization and adherence, and an improvement in symptoms, LVEF, and heart rate control.