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An advanced chronic heart failure day care service: a 5 year single-center experience

Dov Freimark1, Michael Arad, Shlomi Matetzky

  • 1Heart Failure Service, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.

The Israel Medical Association Journal : IMAJ
|November 17, 2009
PubMed

Insights

A specialized heart failure day care service safely reduced hospitalizations and mortality in advanced chronic heart failure (CHF) patients. This supportive model, including multidrug intravenous therapy and patient education, shows significant benefits for managing complex CHF cases.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Clinical Pharmacy

Background:

  • Chronic heart failure (CHF) is a major cause of hospitalizations and mortality.
  • Advanced CHF presents significant management challenges and a poor prognosis.

Purpose of the Study:

  • To evaluate the 5-year experience of a single-center CHF day care service.
  • To identify cardiovascular and non-cardiovascular events in patients treated at the service.
  • To assess the safety and efficacy of treatments administered in the CHF day care setting.

Main Methods:

  • Retrospective study of 190 advanced CHF patients (NYHA class III-IV) treated between 2000-2005.
  • Patients received biweekly 6-hour visits with intravenous therapies including diuretics, dobutamine, dopamine, iron/blood, and nitroprusside.
  • Follow-up data for at least 1 year was obtained for 83% of patients.

Main Results:

  • The study treated 190 advanced CHF patients with a mean age of 65 years and LVEF of 25%.
  • Common treatments included intravenous diuretics (91%), dobutamine (87%), and iron/blood (47%).
  • Mortality was 29.3% (23% due to CHF exacerbation), with a low rehospitalization rate of 0.68/patient/year, primarily for CHF exacerbation (16.5%).

Conclusions:

  • A supportive CHF day care service is safe and beneficial for advanced CHF patients.
  • Multidrug intravenous treatment, monitoring, education, and psychological support can reduce morbidity.
  • This model may contribute to lower-than-expected mortality and hospitalization rates in advanced CHF.
Abstract

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