Abstract
Introduction:
Heart failure (HF) is a pandemic syndrome characterized by raised morbidity and mortality. With the aging population, an acute heart failure event requiring hospitalization is associated with a poor prognosis and demands a longer hospital stay. However, the length of hospital stay and complication will increase if clinical and biochemical parameters are not observed, monitored, and corrected apart from mainstream medications (IV diuretics, ARNIs, BB, MRAs, and SGLT2i).
Objectives:
- Reduction of acute complications (such as AKI, electrolyte imbalance, etc.) related to heart failure medications (IV diuretics).
- Shorten hospital stay.
- Less chance of developing hospital-acquired infections.
- Good quality of life.
Methodology:
A retrospective study of 45 patients was conducted through EPR notes in the Elderly and General Medical wards. We conducted a 2-cycle study on patients with decompensated heart failure based on standard set parameters (Daily weight, targeted fluid balance, daily U&Es, intake-output charting) and looked for complications, length of hospital stay, and adherence to standard set parameters apart from mainstream treatment. Following the first cycle, awareness was raised through teaching sessions and poster presentations in targeted wards. All patients with decompensated heart failure who received IV diuretics were included in the study.
Results:
After interventions, we were able to demonstrate improved results compared to the initial cycle. Target fluid balance improved from 47% to 77%, daily weight from 17% to 43%, strict Intake-output charting 40% to 58%, daily U&Es 81% to 78%, and incidence of AKI 55% from 40%. Interestingly, the length of hospital stay was reduced by 2-3 days between two cycles.
Conclusion:
Strict adherence to clinical and biochemical parameters improved patient outcomes in terms of reducing complications and length of hospital stay in the management of decompensated heart failure. In this QIP we identified that this patient cohort was not adequately monitored. This was due to various barriers ranging from lack of awareness, staff pressures in the wards, and rapid turnover of the patients. Following a limited awareness campaign, we witnessed some improvement in some of the standards. There are, however, still areas of potential improvement. However, education alone is unlikely to address all of the barriers. Further cycles with other interventions such as making monitoring more efficient, streamlined, and electronic dashboards are likely to yield further improvement.
References:
https://doi.org/10.1161/circheartfailure.108.821785.
https://cks.nice.org.uk/topics/heart-failure-chronic/prescribing-information/diuretics/
https://www.rcplondon.ac.uk/file/7440/download.