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Improved outcome with standardized plan for clinical management of acute decompensated chronic heart failure

Edvinsson, Marie Louise LU ; Stenberg, Albin and Åström-Olsson, Karin LU (2019) In Journal of Geriatric Cardiology 16(1). p.12-18
Abstract

Background Our overall goal is to improve clinical care for inpatients with chronic heart failure (CHF). A retrospective assessment of CHF patients admitted to our hospital over the past decade (2005 vs. 2014) indicated a need for better strategies to evaluate clinical treatment, implement best practices and achieve optimal patient outcome. To that purpose, we developed a standardized plan to improve in-hospital treatment of acute decompensated CHF patients. Methods & Results Retrospective chart reviews were conducted to compare three cohorts of CHF patients admitted to the University Hospital of Lund at different time points over a 12-year period: 2005 (365 patients), 2014 (172 patients) and 2017–2018 (57 patients). Little... (More)

Background Our overall goal is to improve clinical care for inpatients with chronic heart failure (CHF). A retrospective assessment of CHF patients admitted to our hospital over the past decade (2005 vs. 2014) indicated a need for better strategies to evaluate clinical treatment, implement best practices and achieve optimal patient outcome. To that purpose, we developed a standardized plan to improve in-hospital treatment of acute decompensated CHF patients. Methods & Results Retrospective chart reviews were conducted to compare three cohorts of CHF patients admitted to the University Hospital of Lund at different time points over a 12-year period: 2005 (365 patients), 2014 (172 patients) and 2017–2018 (57 patients). Little improvement was seen between 2005 and 2014 with respect to one-year mortality (35% vs. 34%) and adequate treatment with recommended medications, e.g., use of renin-angiotensin system blockers (45% vs. 51%). A standardized treatment plan was devised to improve outcomes. A third cohort, treated under the plan (2017–2018), was compared with the 2014 cohort. One-year mortality (18% vs. 34%) and 30-day readmission (5% vs. 30%) were dramatically decreased, and adherence to medication guidelines was achieved. Key elements of the plan included well-defined treatment procedures, enhanced communication and teamwork, education, adequate time for treatment (5 days) and post-discharge follow-up as necessary. Natriuretic peptide (NT-proBNP) levels were useful for assessing patient status, prognosis and response to treatment. Conclusion Development of a standard plan for clinical management of acute decompensated CHF patients resulted in significant improvements in patient outcome, as reflected in decreased rates of 30-day readmission and one-year mortality.

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author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Chronic heart failure, Medication, NT-proBNP, Prognosis
in
Journal of Geriatric Cardiology
volume
16
issue
1
pages
7 pages
publisher
Science Press
external identifiers
  • scopus:85061488879
  • pmid:30800146
ISSN
1671-5411
DOI
10.11909/j.issn.1671-5411.2019.01.002
language
English
LU publication?
yes
id
e23d2454-d5e9-4765-b7f8-fa16e34a1b62
date added to LUP
2019-02-21 13:21:42
date last changed
2024-05-14 02:44:39
@article{e23d2454-d5e9-4765-b7f8-fa16e34a1b62,
  abstract     = {{<p>Background Our overall goal is to improve clinical care for inpatients with chronic heart failure (CHF). A retrospective assessment of CHF patients admitted to our hospital over the past decade (2005 vs. 2014) indicated a need for better strategies to evaluate clinical treatment, implement best practices and achieve optimal patient outcome. To that purpose, we developed a standardized plan to improve in-hospital treatment of acute decompensated CHF patients. Methods &amp; Results Retrospective chart reviews were conducted to compare three cohorts of CHF patients admitted to the University Hospital of Lund at different time points over a 12-year period: 2005 (365 patients), 2014 (172 patients) and 2017–2018 (57 patients). Little improvement was seen between 2005 and 2014 with respect to one-year mortality (35% vs. 34%) and adequate treatment with recommended medications, e.g., use of renin-angiotensin system blockers (45% vs. 51%). A standardized treatment plan was devised to improve outcomes. A third cohort, treated under the plan (2017–2018), was compared with the 2014 cohort. One-year mortality (18% vs. 34%) and 30-day readmission (5% vs. 30%) were dramatically decreased, and adherence to medication guidelines was achieved. Key elements of the plan included well-defined treatment procedures, enhanced communication and teamwork, education, adequate time for treatment (5 days) and post-discharge follow-up as necessary. Natriuretic peptide (NT-proBNP) levels were useful for assessing patient status, prognosis and response to treatment. Conclusion Development of a standard plan for clinical management of acute decompensated CHF patients resulted in significant improvements in patient outcome, as reflected in decreased rates of 30-day readmission and one-year mortality.</p>}},
  author       = {{Edvinsson, Marie Louise and Stenberg, Albin and Åström-Olsson, Karin}},
  issn         = {{1671-5411}},
  keywords     = {{Chronic heart failure; Medication; NT-proBNP; Prognosis}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{12--18}},
  publisher    = {{Science Press}},
  series       = {{Journal of Geriatric Cardiology}},
  title        = {{Improved outcome with standardized plan for clinical management of acute decompensated chronic heart failure}},
  url          = {{http://dx.doi.org/10.11909/j.issn.1671-5411.2019.01.002}},
  doi          = {{10.11909/j.issn.1671-5411.2019.01.002}},
  volume       = {{16}},
  year         = {{2019}},
}