Heart failure (HF) and fluid overload are the two commonest causes of hospitalization, they become more prevalent in our aging population. Approximately 20-25% if all patients admitted with acute HF have had readmission within 30 days. In 12-year time, the heart failure hospitalization has been increased from 15,989 in 2007 to 21,015 in 2019 (30% rise) according to Hospital Authority statistics. It is well recognized that inadequate decongestion is a deterministic risk factor of HF rehospitalization. Accurate assessment and monitoring of volume status are of utmost importance in managing patients with heart failure, no matter in-patient stays or in out-patient day care services. Physical examination including detection of lower limb swelling, presence of chest crepitation and body weight (BW) increment are insensitive surrogate measures of fluid retention. Starting from October 2022, Division of Cardiology, Department of Medicine & Therapeutics has launched the brand-new Ambulatory Heart Failure Clinic with the aim of taking care post-discharge heart failure patients. The post-discharge heart failure clinic is highly recommended by the latest guidelines from European Society of Cardiology (ESC, class Ic evidence) and American College of Cardiology / American Heart Association (ACC/AHA, class IIa evidence). The main focus of our clinic is to titrate guideline directed medical therapies (GDMT) gradually so as to minimalize subsequent HF hospitalization, improve functional status and relieve congestion symptoms. In view of partially decongested state, fluid assessment is undoubtedly a challenging task in day ward setting. Body weight measurement, physical examination and NT-ProBNP could provide guidance in diuretic management but their data were known to be conflicting and difficult to interpret in patients with chronic renal failure. As a result, there is an unmet need of having an accurate, timely and effective tool in fluid status assessment. In this presentation, our unit will demonstrate the non-invasive, fast and reliable measure of lung fluid content by a state-of-art device and see how it correlate with clinical outcomes of our HF patients. 

Heart failure (HF) significantly impacts about 1.2% of the population in Hong Kong, leading to approximately 20,000 related hospitalizations annually. If left untreated, the 5-year mortality rate for HF can exceed 50%. Guideline-directed medical therapy (GDMT) is crucial, as it has been proven to reduce mortality, decrease hospitalizations, and enhance the quality of life in HF patients. Despite its proven efficacy, the optimization of GDMT presents real-world challenges due to several clinical difficulties and barriers.
This presentation will explore the various obstacles in maximizing GDMT for HF patients, categorizing them into patient factors, physician factors, and system factors. Patient factors include a lack of awareness and understanding about the severity of HF, leading to hesitation in adjusting or increasing medication. From the physician's perspective, non-cardiology specialists, primarily general practitioners, may underutilize essential medications due to concerns about potential side effects. Systemically, the lack of established care protocols for patients transitioning from hospital to home after episodes of acute decompensated heart failure and the long intervals between follow-up appointments in busy clinics hinder the timely uptitration of GDMT.
In conclusion, effectively optimizing GDMT is vital for improving HF outcomes but is fraught with challenges. By acknowledging and addressing these impediments, healthcare providers can enhance the implementation of evidence-based practices and improve overall management of heart failure. This effort will not only tackle the immediate barriers but also pave the way for a more comprehensive approach to heart failure care, ultimately leading to improved patient outcomes.

Heart failure (HF) is a progressive disease that is associated with repeated exacerbations and hospitalizations. The rapid increase in the number of HF patients is a global health problem now referred as the "heart failure pandemic". Despite remarkable advances in drug therapy for HF, the residual HF-related morbidity, mortality and hospitalizations remain substantial, and significant proportions of patients with HF remain symptomatic despite optimal best tolerated drug therapy. In particular, there remain significant unmet clinical needs in patients with moderate to severe HF (Stage C and D). 


Novel device-based interventions have emerged as a potential therapy for various phenotypes of HF. The concept of interventional heart failure (IHF) considers heart recovery and prevention of worsening of heart failure via multidisciplinary treatment using surgical, catheter interventions, and mechanical circulatory support devices. There are 3 major phases, namely 1) Life-saving intervention in acute cardiogenic shock, 2) intervention for the underlying aetiology and pathophysiology of heart failure and 3) bridging therapy mainly with hemodynamic support for patients with end-stage heart failure who are transitioning to an implantable left ventricular assist device (LVAD) or waiting for cardiac transplantation.


Telemedicine is potentially a way of escalating HF multidisciplinary integrated care. Many HF patients' stages of instability could be avoided if their follow-ups were improved both in the vulnerable post-hospital discharge phase and in the medium and long term phases. The widespread adoption of mobile technologies offers an opportunity for a new approach to post-discharge care patients. By enabling remote monitoring and two-way real time communication between the clinic and home-based patients, as well as a host of other capabilities, mobile technologies have a potential to significantly improve remote patient care and outcomes. 


Given the increased amount of data generated by virtual healthcare technologies, artificial intelligence (AI) is being investigated as a tool to aid decision making in the context of primary diagnostics, identifying disease phenotypes and predicting treatment outcomes for HF. Opportunities of telemedicine application in HF patients should be explored and adopted. There is a need for evidence-based integration in the workflow of HF management. Support for patients and clinicians wishing to use these technologies is important, along with consideration of data validity and privacy and appropriate recording of decision-making.

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).