Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Fan YYK (1), Wong KLM (1), Yung CY (1), Cheng KY (1), Wong KF (1), Chow YM (1), Au KL
(1), Kong YL (1), Lau KW (1), Lee MY (1), Fu TY (2), Wong TK (2), Yau SFC (3), Chan KW
(3), Siu V (4), Lee A (4), Hung D (5), Wong C (5), Wong E (6)
Affiliation :
(1) Cardiac Medical Unit, Grantham Hospital, (2) Physiotherapy, Grantham Hospital, (3)
Occupational Therapy, Grantham Hospital, (4) Pharmacy, Grantham Hospital (5) Clinical
Psychology, Grantham Hospital (6) Dietetics Services, Grantham Hospital
Introduction :
Heart failure (HF) is a complex clinical syndrome with a global economic burden and is a leading cause of hospitalizations owing to repeated worsening of the disease. Treatment regimens are complex while patient often reports poor quality of life, high levels of psychological distress and difficulties adhering to treatment regimens.
Hospital readmissions reported up to 30% by 90days post discharge. According to 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, it is recommended that HF patients are enrolled in a multidisciplinary HF (MDHF) management program but no formal content of program recommendation is available. To address this service gap, an individualized structured MDHF program is established for patients referred for advanced HF.
Objectives :
1.To set up and implement a de-novo multidisciplinary team to enhance and strengthen holistic support and continuity of care for patients with advanced HF with aims to improve disease control and quality of life, to reduce recurrent HF hospitalization and to improve outcomes. 2.Toengage team members, manage changes and overcome barriers in co-ordination of care.
Methodology :
1)Discussion and regular reviews on ongoing strategies of implementation, managing changes of established processes and adopting new working practices amongst teams 2)Streamline treatment pathways such as patient referral and follow up arrangement, timeliness of assessment, effective communication between team members, other health professionals, and the patients and caregivers, setting up documentation format in CMS, data collection format & patient satisfaction survey. 3) Recruit advanced HF patients who are willing to be enrolled into the structured multidisciplinary cardiac rehabilitation program.4) Baseline assessment and reassessment are conducted to evaluate patient outcomes.
Result & Outcome :
Among the 102 recruited patients (male = 87%);mean age 53.99 +/- 10.7 years old, baseline LVEF was 27.08 +/- 9.24 % ; average number exercise training sessions attended per patient = 28(n=52) Significant reduction of all cause emergency medical admissions 12 months before start of the program compared to 12-monthsafter: mean 1.15 vs 0.32 admissions, p=0.002(n=66) and post 3-month NTproBNP level(1833.79 +/- 2370.47 pg/ml vs 1257.2 +/- 1572.6(n=61) [p < 0.01]. Significant improvement of post 3 month KCCQ score (QoL-full score 100)(65.33 +/- 13.9 vs 71.66 +/- 11.9) (n=54)[p<0.001]; 6MWT = (472.8 +/- 89.2m vs 514.8 +/-84.9m) (n=51) [p=0.001]; Self-Care of Heart Failure Index- Chinese version (p<0.05) and Hospital Anxiety and Depression Scale [p<0.05]Pre score = 11.89 +/- 8.54 vs Post score = 9.56+/- 9.08. Average overall patients’ satisfaction rate = 9.5/10 (n=47). MDHF program is safe and beneficial in pts with advanced HF with significant improvement in patient's outcomes.
