An advanced chronic heart failure day care service: A 5 year single-center experience

Dov Freimark, Michael Arad, Shlomi Matetzky, Isabell DeNeen, Liron Gershovitz, Nira Koren Morag, Naomi Hochberg, Yafit Makmal, Michael Shechter*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Background: Chronic heart failure is associated with excessive hospitalizations and poor prognosis. Objectives: To summarize the 5 year experience of a single-center CHF day care service, detect the cardiovascular and non-cardiovascular events, and evaluate the safety of the treatments provided. Methods: We retrospectively studied all patients admitted to the CHF day care service of the Sheba Medical Center between September 2000 and September 2005. Results: Advanced (New York Heart Association class III-IV) CHF patients (n=190), mean age 65 ± 12 years and left ventricular ejection fraction 25 ± 11%, were treated for 6 hourly biweekly visits; 77% had ischemic and 23% had non-ischemic cardiomyopathy. Treatment included: intravenous diuretic combinations (91%), intermittent low dose (≤ 5 μg/kg/min) dobutamine (87%), low dose (≤ 3 μg/kg/min) dopamine (38%), intravenous iron preparation and/or blood (47%), and intravenous nitropruside (36%). Follow-up of at least 1 year from initiation of therapy was completed in 158 of 190 patients (83%). Forty-six (29.3%) died: 23% due to CHF exacerbation, 5.7% from infection, 4.4% from sudden cardiac death, 3.8% from malignancy, 2.5% from malignant arrhythmias, 1.9% from renal failure, 1.3% from stroke, and 0.6% from myocardial infarction. There were only 0.68 rehospitalizations/patient/year; the most frequent cause being CHF exacerbation (16.5%). Conclusions: Our study demonstrates the safety and potential benefits of a supportive day care service for advanced CHF patients. Multidrug intravenous treatment, accompanied by monitoring of electrolytes, hemoglobin and cardiac rhythm, along with education and psychological support, appear to reduce morbidity in advanced CHF patients and may have contributed to the lower than expected mortality/hospitalization rate.

Original languageEnglish
Pages (from-to)419-425
Number of pages7
JournalIsrael Medical Association Journal
Volume11
Issue number7
StatePublished - 2009

Keywords

  • Angina
  • Coronary disease
  • Heart failure
  • Prognosis

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