Improved outcome with standardized plan for clinical management of acute decompensated chronic heart failure

Background Our overall goal is to improve clinical care for inpatients with chronic heart failure(CHF). A retrospective assessment of CHF patients admitted to our hospital over the past decade(2005 vs. 2014) indicated a need for better strategies to evaluate clinical treatment, implement best practices and achieve optimal patient outcome. To that purpose, we developed a standardized plan to improve in-hospital treatment of acute decompensated CHF patients. Methods & Results Retrospective chart reviews were conducted to compare three cohorts of CHF patients admitted to the University Hospital of Lund at different time points over a 12-year period: 2005(365 patients), 2014(172 patients) and 2017–2018(57 patients). Little improvement was seen between 2005 and 2014 with respect to one-year mortality(35% vs. 34%) and adequate treatment with recommended medications, e.g., use of renin-angiotensin system blockers(45% vs. 51%). A standardized treatment plan was devised to improve outcomes. A third cohort, treated under the plan(2017–2018), was compared with the 2014 cohort. One-year mortality(18% vs. 34%) and 30-day readmission(5% vs. 30%) were dramatically decreased, and adherence to medication guidelines was achieved. Key elements of the plan included well-defined treatment procedures, enhanced communication and teamwork, education, adequate time for treatment(5 days) and post-discharge follow-up as necessary. Natriuretic peptide(NT-proBNP) levels were useful for assessing patient status, prognosis and response to treatment. Conclusion Development of a standard plan for clinical management of acute decompensated CHF patients resulted in significant improvements in patient outcome, as reflected in decreased rates of 30-day readmission and one-year mortality.