1Universitätsklinikum Würzburg Deutsches Zentrum für Herzinsuffizienz Würzburg, Deutschland; 2University Hospital Würzburg Institute for Virology and Immunobiology Würzburg, Deutschland; 3Universitätsklinikum Würzburg Medizinische Klinik und Poliklinik I Würzburg, Deutschland; 4Universitätsklinikum Würzburg Interdisziplinäre Biomaterial- und Datenbank Würzburg (IBDW) Würzburg, Deutschland
Background: Based on solid evidence, the current guidelines on acute and chronic heart failure recommend to initiate a careful follow-up visit within the first 6 weeks following a HF hospitalization. Nevertheless, the implementation of such a care pathway in clinical routine is challenging. We assessed the rate of outpatient visits within 6 weeks after hospitalization for acute heart failure (AHF) and the reasons for non-attendance despite a maximally supportive environment.
Methods: The ongoing Acute Heart Failure–Immunomonitoring Cohort Study (AHF–ImmunoCS) aims to assess prevalence and determinants of autoantibodies exhibiting reactivity against the myocardium in patients with AHF. We include consecutive patients hospitalized for AHF at the University Hospital Würzburg. Exclusion criteria are high urgency listing for heart transplant, high output failure, or left ventricular assist device (LVAD) implanted/planned. Assuming a maximal immune response about 6 weeks after admission, study participants are scheduled for a 6-week follow-up visit at the Comprehensive Heart Failure Center Würzburg, which includes blood sampling and optimization of the heart failure therapy. The study staff maximally supports attendance of the follow-up visit by organizing transport, telephone reminders, and assistance in individual logistic support as needed. In case the outpatient visit cannot be performed, the study staff assesses the respective reason for non-attendance.
Result: N=666 patients were screened. Of those, n=431 patients did not participate (64,72%): mean age 80±11 years, 28% de novo heart failure, 85% in NYHA classes III and IV, median LVEF 51% (quartiles 35; 55), median NT-proBNP 6086 pg/ml (2472; 11907). Reasons for non-participation were lack of interest (18%), physical or mental limitations (55%), language barrier (3%), logistic reasons (13%), or other reasons (11%).
N=235 patients participated in AHF-ImmunoCS (35,28 %): mean age 72±13 years, 39% women, 34% de novo heart failure, 84% in NYHA classes III and IV, LVEF 50% (35; 55), median NT-proBNP 4322 pg/ml (2140; 10948). Of those, n= 232 were scheduled for a 6 week follow-up. N= 175 (75%) attended the 6-week follow-up and n=57 (25%) did not. Of those, n=7 (3%) patients had died and n= 11 (5%) had withdrawn their consent. Further reasons for non-attendance were rehospitalization or prolonged rehabilitation (n=14, 6%), palliative care (n=1, 0.4%), weakness/reduced physical condition (n=6, 2.5%), care for a sick family member (n=1, 0.4%), non-compliance (n=5, 2.2%), and non-specified reasons (n=12, 5.2%).
Conclusion: Even under optimally supported conditions, a substantial number of AHF patients fails to attend an early post-discharge visit. Reasons for non-attendance are diverse and tends to disadvantage the weakest and sickest patients. Tailoring specific programs to support these patients might include remote patient care and home-care support.