Heart failure is a highly debilitating, life-threatening condition that resulting in high mortality and admission rate, and poor quality of life. According to a previous local study, the prevalence of heart failure (HF) in Hong Kong is around 1%. The rate of hospitalization for new onset HF is as high as 9.07 per 1000 population per year for patients age 85 or above. HF is one of the 5 leading causes of hospitalization in Hospital Authority (HA) and also the leading causes of hospital admission and re-admission in QEH. About 10% of daily admissions into the Department of Medicine have a diagnosis of heart failure. Acute heart failure is primarily managed by Physicians in general medical wards, while only a small fraction is managed by cardiologists. With certain diagnostic difficulty, there is a lack of timely diagnosis and thus early initiation of therapy, resulting in longer length of stay. The average length of HF hospital stay is 5.69 +/- 5.09 days (mean +/- SD), ranging from 1 to 28 days in QEH. All-cause mortality was 19.5% at 1 year, 32.1% at 2 year and 54% at 5 years after initial hospitalization for HF. The lack of a reliable biomarker for HF (NT-proBNP) and the long waiting time (>68 weeks) for echocardiogram as a tool for diagnosis and monitoring remain an important problem. Furthermore, the adherence to GDMT was poor (e.g. ACEI/ARB 52.3%, Beta blockers 39%).
The comprehensive heart failure program at QEH is an annual plan program under HA. We have set up a multidisciplinary Heart Failure Team including cardiologist, cardiac nurse, pharmacist, physiotherapist, and occupational therapist since October 2022. We would initiate consultation rounds daily to assess suitable patients admitted to medical ward with shortness of breath and an elevated NTproBNP; manage patients admitted to HF beds and CCU (including sick patients requiring mechanical circulatory support); initiate guideline directed medical therapy (GDMT) in appropriate HF patients with medication reconciliation by Pharmacist. Patients recruited to the HF program will be followed up at the transition clinic at the Heart Failure Cardiac Ambulatory Centre for close monitoring and further optimization. We provide day admissions for HF procedures (e.g. intravenous diuretics, administration of intravenous iron supplement and levosimendan) to control symptoms early or for palliation. There is arrangement of rehabilitation courses by cardiac rehab nurse/Physio/OT. We will present our 1 year data at the conference which shows significant improvement in survival free of hospitalization, optimal titration of medications and improvement in patient symptom scores and functional status (6 minute walk test).
