Multidisciplinary outpatient congestive heart failure clinic: impact on hospital admissions and emergency room visits.

BACKGROUND

Life-saving drugs, such as angiotensin-converting enzyme inhibitors and beta-blockers, are frequently underused and underdosed in patients with heart failure. Specialized clinics have been shown to provide additional benefits.

OBJECTIVES

To determine the impact of a multidisciplinary outpatient heart failure clinic on the frequency of cardiovascular readmissions and emergency room (ER) visits, length of inpatient and ER stays, and New York Heart Association (NYHA) class.

METHODS

A retrospective chart review study comprising 72 patients who had two or more visits to a heart failure clinic between December 1, 1998, and August 31, 1999, was performed. The number of readmissions and ER visits, and the NYHA class were recorded during the six-month period before and after the first visit to the clinic.

RESULTS

Most subjects were in NYHA class III or IV (71% and 21%, respectively), and the mean ejection fraction was 31%. The post- versus preintervention relative risk of readmission was 0.43 (95% CI 0.25 to 0.72). The total number of inpatient days decreased by 54% (95% CI 44% to 62%). The post- versus preintervention relative risk of an ER visit was 0.29 (95% CI 0.19 to 0.45). The number of ER days decreased by 60% (95% CI 41% to 73%). NYHA functional class significantly improved, with most subjects ending the six-month postintervention period in class I or II (33% and 49%, respectively; P=0.001).

CONCLUSIONS

This multidisciplinary heart failure clinic significantly decreased the risk of cardiovascular readmissions and subsequent ER visits. It led to improvement in NYHA class and to a decrease in the number of days spent in the hospital and in the ER.