MP-6 - NOVEL ALGORITHM APPLIED IN PILOT HEART FAILURE CONTINUITY CLINIC MAY CONFER MORTALITY BENEFIT WHEN COMPARED TO USUAL CARE PATHWAY

Background: There is strong evidence to support guideline directed medical therapy (GDMT) in heart failure (HF). However, titration of this therapy is often prolonged, which is associated with negative outcomes. The optimal way to initiate and rapidly titrate therapy to target doses is unknown. We performed a pilot feasibility study of a novel HFrEF medication algorithm in a group of patients newly referred with HF and compared outcomes to a propensity matched control.

METHODS AND RESULTS: Consecutive new patients discharged with new or worsening HF were referred to and followed at a nurse practitioner run, physician supported, heart failure continuity clinic (HFCC) in Southern Alberta. Patients received increased GDMT based on a published cluster algorithm. Using a local discharge abstract data base, a population of contemporary patients were identified that were also discharged with a diagnosis of HF but did not attend the HFCC. Propensity matching was performed to restrict comparisons to control patients most like those that attended the HFCC. Pharmaceutical information network and vital statistic data were used to determine GDMT prescriptions and mortality over the next six months. Fischer exact tests were used to compare medication prescriptions while Kaplan-Meier curves and Cox-proportional hazard ratios were used to compare survival.

Between April 1, 2021 and June 30, 2023, 181 patients who attended the HFCC and 543 that did not were matched based on propensity score. The two groups were similar with respect to sex, age, hypertension, previous myocardial infarction, and previous revascularization, however, there was a trend toward a greater prevalence of diabetes (37.0 vs. 29.8%, p = 0.072) and previous pacemaker implants (6.1 vs. 3.3%, p = 0.1) within the arm that attended the HFCC. For every class of GDMT, prescription rates were significantly higher for those that attended the HFCC (Table 1). A survival analysis suggested a significant reduction in mortality at 6 months that favored those who attended the HFCC (Adjusted HR 0.50, 95% CI 0.26 – 0.95, p=0.035) (Figure 1).


Conclusion: This pilot study suggests that a GDMT medication titration algorithm utilized in a HFCC is an effective strategy to facilitate rapid initiation and titration of HF therapy. Moreover, our data suggest the HFCC model used in this study confers a significant mortality benefit at 6 months when compared to the usual care pathway. Future work will seek to explore other outcomes such as re-hospitalization and how outcomes differ for patients with HFrEF and HFpEF.