Adherence to Heart Failure

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Bdeir, A. Mukhtar, T. Conboy, M. Al-Mallah.

1 Disease Management Programs Adherence to Heart Failure Management Guidelines Raed Odeh, Nurse Specialist Co-Authers: Elias Fadel, MB Bdeir, A. Mukhtar, T. Conboy, M. Al-Mallah. King Abdul Aziz Medical City (KAMC) 22 nd SHA International Symposium, Feb 22, 2011 Riyadh Disclosure: None

2 Background new heart failure (HF) occur each year and more than 5 million Americans have HF 1 In 2007, American Heart Association estimates more than $33 billion were spent on HF 1 HF is the primary or secondary cause for almost 3.6 million hospitalization each year 2 1. AHA, Circulation. 2007;115:e69-e American Heart Association; 2007.

3 Background Implementing clinical practice guidelines results in the best possible health outcomes for patients with HF 1 Despite the compelling scientific evidence that The use of some recommended HF treatment reduce hospitalization ti and mortality in patients t with HF, these life-prolonging therapies continue to be underutilized 2 1. Merit-HF. Lancet 1999; 353: Fonarrow, GC, Thw European J. of HF 7 (2005)

4 Objective Primary objective: is to examine the adherence of the nurse-lead heart failure (HF) Disease Management Programs (DMP) to international heart failure management guidelines Secondary objective: is to compare nurse lead DMP s adherence to international HF management guidelines with one other known international registries, The Get With The Guidelines AHA registry (GWTG)

5 GWTG Participation i Module Contracted hospitals Patients Enrolled No. of Records Entered CAD CAD/HF ,756 26, ,731 30,643 Stroke ,117, ,156, Heart Failure , ,278 total ,989,612 2,144,535 Jan, 2010

6 Methodology Retrospective study Inclusion Criteria: All adult patients with systolic heart failure enrolled in KAMC HF DMP from Have at least one follow up visit it after their initial iti enrollment All patients must have EF 40% at their initial enrollment

7 Disease Management Programs (DMP) Complete approach to care of a particular disease including prevention, treatment and follow-up care and implementations of guidelines 1 DMPs are effective in 2 : Reducing hospital readmissions Improving quality of life Improving the application of proven therapies Reducing costs Possibly lengthening survival 1. Freeman DA et al,dis Manag Health outcomes,1998;1: Roccaforte R et al, A meta-nalysis, Euro J Heart Failure 2005;7 :

8 Cardiovascular Disease Management Program (KAMC) Established in clients with HF Nurse-lead, directed by a cardiologist and supported by a multidisciplinary team Special training in HF management Target orientated program Care starts from the in-patient (September, 2008)

9 Data Collection Patient s data is prospectively collected and entered in a computerized database on each clinic visit Data collected includes demographics, symptoms, problem list, risk factors, laboratory results, medications, etiology, complete medical exam, vitals etc..

10 Database

11 Statistical Analysis The original prospectively collected data was examined and analyzed Analysis was performed using the SPSS program Continuous data was presented as mean ± standard deviation and were compared using t-test Categorical data was presented as frequencies and compared using Chi Square /Fisher exact test

12 Study Analysis The use of ACEI, Beta-Blockers, device implantation, systolic blood pressure, and HR control from the initial enrollment visit and the last follow up visit were examined and compared together Then the findings from the last follow up visit was compared to the GWTG AHA registry findings which was published by Hernandez et al in JAMA, May 5, 2010-Vol 303, No. 17

13 General Characteristics Population 1217 pts Age Mean ± std 57±12 yrs Male Gender % 72% Dyslipidemia 77% PCI 22% CABG 22% History of Renal Disease 5% History of Thyroid 11% History of Smoking 44% History of COPD 9%

14 Etiology Classification

15 Outcomes Enrollment Follow up N 1217 N 1217 P. Value EF Mean ± std 31% ±9 37% ±11 <0.001 NYHA I % 64% 66% o.74 NYHA II % 30% 29% 0.76 NYHA III % 6% 5% 0.58 Systolic BP 119 ± ± MMhg Mean ± std Diastolic BP 70 ±12 73 ± MMhg Mean ± std Heart Rate BPM 75 ±13 71 ± Mean ± std

16 Enrollment vs. Follow-up

17 I ti t R l Inpatient Role P.= 0.053

18 KAMC vs. GWTG P= P.= <

19 Conclusion & Clinical Implications CVDMP staff adhere to international guidelines Significant difference in adherence to guidelines in favor of the DMPs compared to GWTG AHA DMP is a successful approach in adhering and implementing international guidelines and should be widely applied

20 Future Directions Further research is needed to examine the nurses compliance in maximizing the dosage of the recommended HF treatments Educating the team / the patient regarding the benefits of the AICD implant needs to be addressed and followed up

Online Appendix (JACC )

Online Appendix (JACC ) Beta blockers in Heart Failure Collaborative Group Online Appendix (JACC013117-0413) Heart rate, heart rhythm and prognostic effect of beta-blockers in heart failure: individual-patient data meta-analysis