The prognostic role of follow-up at a multidisciplinary Heart Failure Outpatient Clinic in heart failure with reduced ejection fraction: the fifth element of the modern complex care

Abstract

The 2021 European Society of Cardiology (ESC) Heart Failure (HF) Guidelines (GLs) recommend enrolling all HF patients in a multidisciplinary HF management programme to improve the prognosis. However, the accessibility of HF Outpatient Clinics (HFOCs) in real-world clinical practice remains suboptimal. To assess the real-world effect of multidisciplinary follow-up (FUP) at an HFOC on the composite endpoint of 1-year all-cause mortality (ACM)/HF hospitalisation (HFH) in a consecutive cohort of patients after a hospitalisation for HF with reduced ejection fraction (HFrEF), using propensity-score matching (PSM) analysis in light of the modern GL-directed medical therapy (GDMT). The data of a consecutive group of 551 patients (male: 75%, age: 63 [52-71] years, de novo HF: 42%, LVEF: 25 [20-30]%, coronary artery disease: 45%, hypertension: 68%, diabetes: 40%, eGFR < 60 mL/min/1.73m2: 52%, NT-proBNP at hospital admission: 5866 [2728-10616] pg/mL, GDMT at discharge: RASi/target doses [TD] of RASi: 94%/18%, βB/TD βB: 85%/7%, MRA/TD MRA: 95%/64%, SGLT2i: 68%, triple therapy [TT: RASi + βB + MRA]/TD TT: 82%/2%, quadruple therapy [QT: TT + SGLT2i]/TD QT: 61%/2%, CRT-P/CRT: 13%, ICD without CRT-D: 13%) hospitalised for HFrEF between 2021 and 2025 at our cardiology centre were analysed. Patients followed up at our HFOC were matched in a 1:1 ratio with patients not followed up at our HFOC using the nearest neighbour matching method with adjustment for possible confounders at hospital discharge (female sex, age, de novo HFrEF, coronary artery disease, atrial fibrillation, diabetes, hypertension, systolic blood pressure, heart rate, creatinine-, potassium-, haemoglobin level, LVEF, CRT, RASi-, βB-, MRA-, SGLT2i medication). In the PSM cohort, the composite endpoint of 1-year ACM/HFH was examined, as was the GDMT application rate at 1 year. In the total cohort, the composite of 1-year ACM/HFH occurred in 28% of patients (ACM: 16%, HFH: 18%). In the PSM cohort (n=332), 1-year ACM/HFH affected 23% of the HFOC patients and 33% of the non-HFOC patients. FUP at the HFOC was accompanied by a 34.5% relative risk reduction of ACM/HFH (adjusted HR: 0.655, 95% CI: 0.434-0.987, p=0.043) even within 1 year. At 1 year, 76% of the total cohort received TT (TD TT: 9%), while 60% had QT (TD QT: 7%). Evaluating GDMT in the PSM subgroup, at 1-year follow-up, HFOC patients were significantly more frequently treated with QT (67% vs 53%, p=0.038; HFOC vs non-HFOC) and TD MRA therapy (64% vs 51%, p=0.022; HFOC vs non-HFOC), while a trend was observed in the TD QT use (10% vs 4%; HFOC vs non-HFOC; p>0.05). Our real-world PSM analysis confirmed that FUP at a multidisciplinary HFOC after hospitalisation for HFrEF can reduce the risk of ACM/HFH within 1 year by 34.5%. Besides, the complex care at an HFOC improved in the long-term the application of GDMT, with a significantly higher QT application rate.MB HOFC PSM prognosisMB Pharmacotherapy