Cardiac outreach services reduce mortality and readmissions

Heart failure (HF) is a major cause of morbidity and mortality worldwide. Despite significant improvements in the management of HF, the overall outcome remains poor. In addition to pharmacotherapy and device therapy, non-pharmacological interventions are needed to mitigate the effects of this illness. The aim of this study was to evaluate the impact of the HF outreach programme on the rate of mortality, HF hospitalisations and guideline-directed medical therapy (GDMT) for HF in South-Western Sydney Local Health District (SWSLHD).

In this observational, registry-based study, adult patients diagnosed with HF with reduced ejection fraction (HFrEF) in SWSLHD were invited to participate in the HF outreach service between March 2011 and January 2016. The primary outcome was all-cause mortality. The secondary outcomes were the rate of optimal GDMT and HF hospitalisations.

There were 818 patients included in the study; 470 (57.5%) patients were enrolled and 348 (42.5%) not enrolled into the programme. At the end of the follow-up period (median 978 days, IQR 720-1237), the primary outcome of mortality was observed less in the enrolled group (122 (26%) vs 133 (38.2%), p<0.001) independently of other variables. In addition, fewer enrolled patients had >3 hospital admissions for HF (16.2% vs 35.6%, p<0.001) and reduced median admission days (14.5 days (IQR 8-25) vs 22 days (IQR 12-37), p<0.001). Patients enrolled into the programme were more likely to be on optimal GDMT (76.6% vs 56.6%, p<0.001).

Enrolment in the HF outreach programme was associated with a significant reduction in mortality and the frequency and length of hospital HF admissions. In addition, the rate of optimal GDMT was significantly higher in the enrolled group. With the high prevalence of HF, these programmes should be considered in the routine management of patients with HFrEF.