Authors (including presenting author) :
Shum CK(1), Ho KS(1), Chu HM(2), Ho MY(2), Fu TY(1), Wong CL(2), Li SS(3), Wang KN(3), Kwok LC(3), Lam CC(3), Tse CS(4), Ip HTJ(4), Ng KP(4), Chow PKD(4), Chan HK(4), Mak MYM (4), Wong PS(5), Kwok KL(5), Chan WY(5), Cheung TY(5), Yiu D(3), Chao FW(3), Kwok WY(3), Mok CK(1), Kwan YK(1), Wong WM(1), Chan NH(2), Ng MF(1)
Affiliation :
(1) Division of Geriatrics, Department of Medicine and Geriatrics, Tuen Mun Hospital (2) Division of Geriatrics, Department of Medicine and Geriatrics, Pok Oi Hospital/Tin Shui Wai Hospital (3) Community Care Department (4) Department of Physiotherapy, Tuen Mun Hospital (5) Department of Occupational Therapy, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
Introduction :
Heart failure patients, especially older adults, have high rates of readmission and mortality after discharge from acute heart failure but are often under-treated. Studies found that high intensity care led to better use of heart failure medications and reduced heart failure hospitalization and mortality in community-dwelling adult patients. However, data are scarce for frail older adults living in residential care homes (RCHs).
Objectives :
(1) To allow a safe and rapid up-titration of evidence-based medications after acute heart failure according to international guidelines; and (2) To reduce heart failure hospitalization in frail older adults living in RCHs.
Methodology :
A Smart Heart Failure Program was piloted with an innovative use of telehealth and multidisciplinary team support to cover 97 RCHs under New Territories West Cluster Community Geriatric Assessment Service. Target patients were older adults (aged 65 years or above) living in RCHs with recurrent (2 or more) heart failure hospitalization in previous 3 months. Patients would be followed up for 3 months with (1) telehealth doctor clinics to allow rapid up-titration of heart failure medications and treat other comorbidities; (2) nursing visits to empower RCH staff for disease monitoring and medication supervision; and (3) exercise rehabilitation by physiotherapists and occupational therapists.
Result & Outcome :
From February 2024 to January 2025, a total of 26 patients aged 66-95 years (mean±SD 85.5±7.7 years; female 65.4%) were recruited. Heart failure types included 42.3% HFrEF, 38.5% HFpEF, 11.5% HFmrEF, and 7.7% unspecified. All were frail (clinical frailty scale 5-8) and had other cardiovascular comorbidities. At the end of the program, 80.8% of patients received either more heart failure medications or medications at higher dosages. They had lower rates of heart failure hospitalization (pre-intervention 2.4±0.7 vs. post-intervention 0.2±0.4 at 3 months, p<0.001) and shorter hospital length of stay due to heart failure (pre-intervention 22.0±15.2 vs. post-intervention 1.1±2.2 days at 3 months, p<0.001). There was no admission due to adverse drug reactions. Assumed that patients would have the same pattern of heart failure hospitalization without the program, 545 hospital bed days were saved for 26 patients (i.e. saved 21 hospital bed days per patient). The Smart Heart Failure Program is an innovative, safe, effective and potentially health care cost-saving discharge support program to reduce recurrent heart failure hospitalization in older adults living in RCHs. Future extension of the program may include patients with single heart failure admission or other reasons of emergency hospitalization.
