Related Experiment Videos
Symptomatic improvement and reduced hospitalization for patients attending a cardiomyopathy clinic
1Cardiology Section, Jerry L. Pettis Veterans Administration Medical Center, Loma Linda, California 92354, USA.
Insights
Intensive care in a cardiomyopathy clinic significantly improved heart failure symptoms and ejection fraction while drastically reducing hospitalizations and emergency visits for heart failure patients.
Area of Science:
- Cardiology
- Heart Failure Management
- Clinical Outcomes
Background:
- Congestive heart failure (CHF) management incurs substantial inpatient costs.
- Outcome studies are crucial to assess the cost-effectiveness and efficacy of intensive outpatient care for heart failure.
Purpose of the Study:
- To evaluate the impact of specialized cardiomyopathy clinic care on cardiac function, symptoms, and healthcare utilization.
- To determine if this model of care can reduce hospital admissions and emergency department visits for heart failure patients.
Main Methods:
- A 6-month prospective study of 21 heart failure patients (ejection fraction < 0.45) managed in a cardiomyopathy clinic.
- Assessment included quality of life questionnaires, echocardiograms, radionuclide left ventriculograms, and cardiopulmonary exercise testing.
- Healthcare utilization (hospitalizations, clinic/emergency visits) was compared for 6 months pre- and during-study periods.
Main Results:
- Significant improvements observed: Minnesota Living with Heart Failure score increased by 23 points, NYHA class decreased from 2.6 to 2.2.
- Ejection fraction improved from 0.24 to 0.36; left ventricular dimensions decreased.
- An 86% reduction in CHF hospitalizations and a 100% reduction in emergency visits were recorded.
Conclusions:
- Management within a dedicated cardiomyopathy clinic can enhance patient quality of life.
- This specialized care model leads to symptomatic improvement and a significant decrease in hospitalizations for heart failure.
Background:
The major costs associated with the management of congestive heart failure (CHF) are inpatient costs. Outcome studies are therefore important to establish whether intensive outpatient care for heart failure can reduce these costs while at the same time improving outcomes in this disabling disorder.
Hypothesis:
Care delivered in a cardiomyopathy clinic might result in objective improvement in cardiac function and symptoms while reducing hospital admissions and emergency department visits.
Methods:
The outcomes of 21 patients treated for 6 months in a cardiomyopathy clinic are evaluated. New patients referred to the clinic with ejection fraction (EF) < 0.45 were enrolled. The Minnesota Living with Heart Failure questionnaire was completed at initial and final visits. All patients underwent baseline and final echocardiogram, radionuclide left ventriculogram, and cardiopulmonary exercise testing. Patients were followed by a nurse practitioner and a cardiologist with maximization of standard treatment. Congestive heart failure-related hospitalizations and clinic and emergency room visits for both 6-month periods before and during the study were determined.
Results:
There was significant (p < 0.05) improvement in these parameters: Heart failure score increased 23 points; New York Heart Association class decreased from 2.6 to 2.2; EF increased from 0.24 to 0.36; diastolic and systolic left ventricular dimensions decreased from 65 to 59 mm and from 57 to 50 mm, respectively. The number of clinic visits increased 5-fold, whereas there were 86% (14 to 2, p = 0.017) and 100% (8 to 0, p = 0.002) reductions in the number of CHF hospitalizations and emergency visits. There was one death during follow-up.
Conclusion:
Managing patients in a cardiomyopathy clinic may result in a better quality of life, with both symptomatic improvement and decreased hospitalizations.