DOI: 10.1161/circ.148.suppl_1.18190 ISSN: 0009-7322

Abstract 18190: Role of Specialised Heart Failure Unit in Optimisation of Guideline-Directed Medical Therapy With Focus on Renal Function - Real World Data

Elizabeth L Macken, Marco Ferrari, Salia Virxinia Pol, Lilly Mandanrano, Heba Ghazal, Omar Ali, Robin Ray, Nesan Shanmugam, Lisa Anderson, Giuseppe Rosano, Marco Metra, Debasish Banerjee, Fadi Jouhra
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Guideline-directed medical therapy (GDMT) has proven to significantly reduce morbidity and mortality in Heart Failure. We highlighted the differences in renal function among HF patients managed on GDMT, comparing those within a dedicated HF unit (HFU) to those under General Medical (GM) and Geriatrics (GER).

Aim: The purpose of this single-centre cohort study is to highlight differences in renal function outcome between these groups.

Methods: Our database consists of 540 patients with AHF admitted to HFU or GM/GER from 01/08/2021 to 31/07/2022. We divided this group as follows:

Group A
: 267 patients from GM/GER.
Group B
: 273 patients in HFU.Groups were classified by ejection fraction(HFrEF/HFmrEF/HFpEF). We analyzed eGFR, K+ and Creatinine(Cr) on admission(adm) and discharge(dc).


Group A(GM/GER)
: HFrEF patients had average eGFR of 45.70(mL/min) on adm and 43.58 on dc. HFmrEF subgroups had eGFR of 48.60 on adm and 46.54 on dc. HFpEF subgroups had eGFR of 50.16 on adm and 47.75 on dc.
Group B(HFU):
Patients with HFrEF had eGFR of 53.50 on adm and 50.74 on dc. HFmrEF subgroup had adm eGFR of 49.48 and 47.01 on dc. HFpEF subgroups had eGFR of 45.95 on adm and 41.72 on dc.
Group A and B comparison
: We have previously demonstrated (Fig.1) that among patients with AHF managed in HFU, there is better optimisation of GDMT. Within the HFrEF cohort, eGFR decreased -2.76 in Group B, with reduction of -2.12 in Group A. Group B HFmrEF showed reduced eGFR of -2.47; Group A decreased -2.06. In HFpEF, eGFR reduced -4.23 in Group B. In Group A, eGFR decreased -2.41. An inpatient mortality of 15.73% was calculated in Group A, contrasting significantly with 6.23% among the HFU cohort.

Conclusion: This study highlights differences in renal function outcome between these two groups. It demonstrates that despite optimisation and initiation of GDMT in Group B - which may lead to concern for its impact on renal function - eGFR, Cr and K+ levels were not markedly different between both cohorts.

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