SPC365

The experience of 253 early post discharge Heart Failure appointments: what we have learned

Session: SESSÃO DE COMUNICAÇÕES ORAIS 03 - EPIDEMIOLOGIA E ORGANIZAÇÃO DE CUIDADOS DE SAÚDE
Speaker: Ana Filipa Mesquita Gerardo

Congress: CPC 2025
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.7 Chronic Heart Failure - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: Ana Filipa Mesquita Gerardo; Inês Miranda; Mariana Passos; Inês Fialho; Célia Henriques; Ana Oliveira Soares; Carolina Mateus; Mara Sarmento; Rodrigo Brandão; David Roque
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Background: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Heart Failure (HF) guidelines recommend a follow-up visit within 7 to 14 days post-hospitalization to facilitate a high-quality transition to outpatient care. This provides an excellent opportunity to monitor signs and symptoms of HF, assess potential treatment side effects and titrate medication accordingly. This strategy has been associated with lower 30-day readmission rates in retrospective studies.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Objectives:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"> To describe the role of HF early post discharge appointment (EPDA) in the management of HF patients and the outcomes of these patients immediately after hospitalization.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Methods: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Prospective registry<strong> </strong>of consecutive patients</span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"> who underwent an EPDA between March 2021 and September 2023. Demographics, blood test results, treatment decisions, and HF-related readmissions and all-cause death at 90 days were recorded. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Results: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">A total of 253<strong> </strong>patients were included, with 35.2% females (n=89) and a median age of 68 [56-76] years. De novo HF was present in 48.2% (n=122) patients; 77.9% (n=197) had reduced left ventricle ejection fraction, and its etiology was still under investigation at the time of EPDA in 43.1% (n=109) patients. Among patients with a known etiology, the majority (54.9%; n=79) had ischemic heart disease. The median time between hospital discharge and EPDA was 13 [10-16] days. Just 2 weeks after discharge, there was already an increase in NYHA class in 10.3% (n=26) of patients, and 18.2% (n=46) already showed signs and symptoms of hypervolemia, requiring diuretic treatment intensification. Guideline medical directed treatment (GMDT) adjustments at EPDA are presented in Graph 1. At EPDA, 17.4% (n=44) of patients experienced drug adverse effects: 4.3% (n=11) hyperkalemia, 5.5% (n=14) hypotension and 9.5% (n=24) acute kidney injury; no one had bradycardia. At discharge 52.6% (n=133) of patients were on the 4 pharmacologic pillars, and this rate increased only to 56.5% (143) at the EPDA, with the mineralocorticoid receptor antagonists being the least prescribed class. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Serum creatinine level (1.1 vs 1.3 mg/dL, p=0.001), serum C cystatin level (1.5 vs 1.9 mg/dL, p=0.006), serum urea level (50.3 vs 57.8 mg/dL, p=0.005), serum NTproBNP level (1847 vs 4877 mg/dL, p&lt;0.001) and furosemide dosage (42 vs 56mg, p=0.01) at EPDA were associated with HF-related readmissions and all-cause death at 90 days. <span style="color:black">Logistic regression analysis revealed that only NTproBNP level at EPDA remained independently associated with adverse events </span><span style="background-color:white"><span style="color:#333333">(p=0.031).</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Conclusions: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Early evaluation of HF patients after discharge allows congestion reassessment, GMDT titration, and detection of drug adverse effects. NTproBNP and kidney function <span style="color:black">measured around 2 weeks after discharge following an acute HF episode</span> are strong predictors of <span style="color:black">HF-related readmissions and all-cause death at 90 days, allowing </span>identification of high-risk patients that<span style="color:black"> should be reassessed earlier. </span></span></span></span></span></p>