Heart failure therapeutic units and clinical outcomes

Background

Heart failure (HF) continues to be a prevalent condition with high morbidity and mortality. To address this, we established a Heart Failure Therapeutic Unit (HFTU) focused on promptly optimizing medical treatment.

Purpose

The primary objective was to evaluate the impact of the HFTU on reducing cardiovascular mortality and HF rehospitalizations at 1 year. Secondary objectives included assessing the impact of the HFTU on treatment dose optimization.

Methods

We conducted a prospective, longitudinal, and single-center study with a 1 year follow-up period. The HFTU group received frequent follow-ups and rapid medication optimization, while the control group received standard care.

Results

We included 299 patients with chronic HF, 234 in the HFTU group and 65 in the control group. The mean age was 63,4±11,6 years, with a predominance of males (76,3%) and a high prevalence of ischemic cardiomyopathy (55.9%). At inclusion, the mean left ventricular ejection fraction (LVEF) was 32.5±10.3%.

The HFTU group demonstrated a significant reduction in cardiovascular mortality and HF rehospitalizations (11.1% vs 41.5%, p<0.001), as well as a significant decrease in HF rehospitalizations (6.4% vs 36.9%, p<0.001), compared to controls, irrespective of age, gender, comorbidities and LVEF. Optimal medical treatment was more common in the HFTU group (p<0.001), alongside improvements in dyspnea (p<0.001), LVEF (from ≤ 40% to > 40%) (p=0.003) and heart rate control (HR<70bpm) (p=0.007).

Conclusion

The HFTU significantly reduced the combined endpoint of cardiovascular mortality and HF rehospitalizations, as well as HF rehospitalizations alone, while improving medication optimization, symptoms, LVEF, and heart rate control, demonstrating its efficacy in managing HF.