Developing a contemporary community clinic for patients with heart failure with preserved ejection fraction within the current National Health Service model

Patrick Tran, Thomas Long, Jessica Smith, Michael Kuehl, Tarek Mahdy, Prithwish Banerjee

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    Abstract

    IntroductionThe diagnostic and therapeutic arsenal for heart failure with preserved ejection (HFpEF) has expanded. With novel therapies (eg, sodium-glucose co-transporter 2 inhibitors) and firmer recommendations to optimise non-cardiac comorbidities, it is unclear if outpatient HFpEF models can adequately deliver this. We; therefore, evaluated the efficacy of an existing dedicated HFpEF clinic to find innovative ways to design a more comprehensive model tailored to the modern era of HFpEF.MethodsA single-centre retrospective analysis of 202 HFpEF outpatients was performed over 12 months before the COVID-19 pandemic. Baseline characteristics, clinic activities (eg, medication changes, lifestyle modifications, management of comorbidities) and follow-up arrangements were compared between a HFpEF and general cardiology clinic to assess their impact on mortality and morbidity at 6 and 12 months.ResultsBetween the two clinic groups, the sample population was evenly matched with a typical HFpEF profile (mean age 79±9.6 years, 55% female and a high prevalence of cardiometabolic comorbidities). While follow-up practices were similar, the HFpEF clinic delivered significantly more interventions on lifestyle changes, blood pressure and heart rate control (p60% of hospitalisation, including causes of recurrent admissions.ConclusionThis study suggests that existing general and emerging dedicated HFpEF clinics may not be adequate in addressing the multifaceted aspects of HFpEF as clinic activities concentrated primarily on cardiological measures. Although the small cohort and short follow-up period are important limitations, this study reminds clinicians that HFpEF patients are more at risk of non-cardiac than HF-related events. We have therefore proposed a pragmatic framework that can comprehensively deliver the modern guideline-directed recommendations and management of non-cardiac comorbidities through a multidisciplinary approach.
    Original languageEnglish
    Article numbere002101
    Number of pages10
    JournalOpen Heart
    Volume9
    Issue number2
    DOIs
    Publication statusPublished - 4 Nov 2022

    Bibliographical note

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

    Funder

    The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for- profit sectors. Publisher Copyright: © 2022 Author(s) (or their employer(s))

    Keywords

    • Heart Failure
    • Palliative care
    • risk factors
    • Health Services
    • Cardiac Rehabilitation
    • Humans
    • Stroke Volume
    • Retrospective Studies
    • Aged
    • Aged, 80 and over
    • Ambulatory Care Facilities
    • State Medicine
    • Female
    • Male
    • Pandemics
    • COVID-19

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