Das Konzept der Herzinsuffizienz- klinik: integriertes diagnostisches und therapeutisches Vorgehen bei Patienten mit linksventrikulärer systolischer Dysfunktion

Studies on the effect of heart failure clinics have been encouraging with respect to reduced hospitalization, improved quality of life and reduced cost. However, hitherto presented results have been derived from patient populations either recently discharged and with specific exclusion criteria, or from heart transplant lists. We here report the establishment of a heart failure clinic, the baseline characteristics of the first 283 patients treated, and the impact on heart failure hospitalisations during establishment. Since September 1st, 1999, a heart failure clinic has been operated at Frederiksberg University Hospital, covering a metropolitan area of Copenhagen, Denmark. The clinic was designed with both a diagnostic and a therapeutic unit. The diagnostic unit offers open access to all patients with suspected heart failure, either through referral from general practitioners or from the medical departments of the hospital. In case of confirmed systolic heart failure, the patient is referred to the therapeutic unit for (1.) uptitration and optimization of medical therapy and (2.) thorough information and education. In addition the unit offers a rapid access track and the possibility of intravenous diuretic treatment. During the 21 months of operation a total of 460 patients were referred to the clinic. Of these 320 (70%) were found to have clinical evidence of heart failure, and 283 (88% of the heart failure patients) had left ventricular (LV) systolic dysfunction (defined by an ejection fraction ≤0.45). These patients were seen in the clinic for education, control of fluid retention and uptitration of medications. These patients with LV dysfunction were predominantly elderly (72.7 ± 10.7 years) and most often male (73%). Ischemic heart disease was the most common etiology (55%). Before referral most patients with LV dysfunction had been treated with none or only low dose ACE inhibitor (55%), and less than one third received beta-blockers (29%). During the first year of operation of the clinic there was a 23% decline of heart failure related hospital admissions to the department of cardiology (from 396 to 306). The establishment of a heart failure clinic which offers the combination of diagnosing and managing congestive heart failure appears to be efficient both in terms of therapy optimization and with respect to a concomitant decline in hospitalization for heart failure.