Abstract 3898: Implementation of a Novel Pathway for Management of Acute Decompensated Heart Failure Improves Guidelines Adherence Along With Decreases in Mortality and Readmissions: A Four Years ACAP-HF Analysis
Background: Clinical guidelines for the management of acute decompensated heart Failure (ADHF) have consistently shown a major gap between the national guidelines and their application in the actual management of patients with ADHF. In 2004 a new program “Advanced Cardiac Admission Program” ACAP was developed and implemented at our Institution. The program consists of tools and strategies for implementing guidelines.
Methods: 747 patients admitted with ADHF were risk stratified on admission and managed according to our implemented pathway. Implementation feasibility and clinical response were reviewed at 48 months, and compared to published national statistics for hospital performances.
Results: Over the past 4 years, B blocker utilization rate at discharge improved from 35% to 76%; p<0.001, ACEi/ARB utilization also improved from 72% to 96%; p<0.001 and aldosterone-antagonists usage increased from 25% to 56% (p<0.001). Most importantly, the event rate post-pathway implementation at four years following hospital discharge shows decreased re-hospitalization from 46% to 24% (p<0.001), marked decrease in mortality from 22% to 7% (p<0.01) (Graph). The length of stay decreased from 7.8 days to 5.5 days (p=0.06).
Conclusion: Implementation of a novel pathway for management of acute decompensated heart failure improves guidelines adherence and significantly decreases mortality and readmission rates at four years follow up.