The Implementation of a Novel Tool to Facilitate Rapid Optimisation in Nurse-Led Heart Failure Clinics
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Authors
J Rungusumy
E Arbenser
A Bentley
J Brown
L Daniel
K Fincham
E Hegarty
C Maciejewska
S Saboor
S Sonson
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Issue Date
2025
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Abstract
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Abstract
Background
Heart Failure (HF) is a progressive condition with periods of apparent stability and repeated worsening HF events.
Unless optimised on HF treatment, worsening HF events become more frequent, and patients enter a cycle of recurrent events associated with high morbidity and mortality rates.
STRONG–HF demonstrated that patients with acute HF can be safely up-titrated to the full optimal dose of Guideline Directed Medical Therapies (GDMTs) within weeks after hospital discharge
The higher the achieved dose of GDMTs, the better the outcomes and improvement to quality of life
Historically, the titration process at Croydon is slow and needed reform to meet international guidelines
Aim
To develop a rapid optimisation clinic to fully optimise patients at 6 weeks, based on the European Society of Cardiology recommendations.
To reduce lengthy titration process currently in place which is variable across the Croydon community networks, in some cases taking over 12 months to fully optimise
To improve quality of life and patient symptom burden based on the quality-of-life questionnaire
To determine how safe a rapid titrate clinic is in real world practice
Results
A total number of 91 patients were seen in the first 6 months of starting the clinic. The following outcomes are reported for 71 patients as they have completed the optimisation process whilst 20 patients are still being optimised at the time of this poster presentation.
14 patients were discharged to community HFNS clinic after initial review as they were not appropriate for rapid titration
78% of patients were established on 4 pillars of HF therapy
On average, 73% of target doses of GDMT were achieved
72% of patients had an improved Quality of life score
Average number of weeks to complete titration process was 6 weeks
Average number of reviews was 4
There were no admissions within first 6 months with decompensated HF or complications from medication titration.
Conclusion
We have developed a novel rapid optimisation clinic which has allowed patients to be quickly titrated within the recommended time and in a safe manner. This demonstrates that by adhering to our protocol, patient outcomes can be vastly improved
Description
CLINICAL SERVICE/SERVICE IMPROVEMENT PODIUM PRESENTATION WINNER (2025)