Introduction of a new scoring tool to identify clinically stable heart failure patients

Area of Science:

• Cardiology
• Healthcare Management
• Clinical Assessment

Background:

• Heart failure (HF) presents a significant challenge to specialist care systems.
• Efficient referral of stable HF patients to primary care is a desirable but currently unstructured goal.

Purpose of the Study:

• To introduce and evaluate the Maastricht Instability Score-Heart Failure (MIS-HF) questionnaire.
• To determine if MIS-HF can objectively stratify heart failure patients for appropriate care settings.

Main Methods:

• Developed the MIS-HF questionnaire to score HF patient clinical stability (0-2 points for low score/stable, >2 for high score/unstable).
• Evaluated MIS-HF in 637 consecutive HF patients at Maastricht University Medical Centre (2015-2018).
• Assessed referral rates to primary vs. secondary care based on MIS-HF scores and tracked primary composite endpoints (mortality, hospital admissions) after one year.

Main Results:

• 52% of patients had a low MIS-HF score; 62% of these were referred to primary care.
• Patients with high MIS-HF scores (48%) were predominantly managed in secondary care (86%).
• The composite endpoint occurred significantly more in high-score patients (29.2%) vs. low-score patients (10.9%). No significant difference in outcomes was observed for low-score patients managed in primary vs. secondary care.

Conclusions:

• The MIS-HF questionnaire is a valuable tool for identifying heart failure patients suitable for safe referral to primary care.
• Implementing MIS-HF can potentially optimize referral policies and streamline HF patient management between primary and secondary care settings.