{
  "abstract": "Introduction Risk of rehospitalisation and death is high after discharge with acute heart failure (AHF). Intensive follow-up strategy (every 1-2 weeks post-discharge) led to better weight monitoring compliance; with more days alive and well out of hospital (DAWOH). But this strategy is not sustainable within Cardiology. Frail older patients may not tolerate guideline directed medical therapy due to falls or renal impairment; they may benefit from Geriatrician input. We tested the hypothesis: intensive follow-up by a Consultant Geriatrician with special interest in HF leads to comparable outcome under Cardiology.Methods 48 patients discharged with an admission diagnosis of HF were followed up over a 12-month period intensively (weekly for one month post discharge). 17 were admitted to acute care of older people female ward, 31 were followed up by Cardiology.Intensive weekly follow-up assessed early signs of decompensation, optimised medication by phone or face-to-face at patient’s rehabilitation facility. Patients were given advice to monitor HF symptoms; a diary sheet for daily weight, whether they felt well each day out of hospital up to 30 days post-discharge.Primary outcome is DAWOH at 30 days- a novel patient-centred endpoint, designed by our patient public involvement group. Secondary outcome includes 1-year mortality and number of days with weight recorded.Descriptive statistics are presented as median [IQR] and compared using the Mann-Whitney test unless if one way Kolmogorov-Smirnov test 2-tailed p>0.05 (the residual is normally distributed). UNIANOVA compares means of normally distributed variables. Chi-squared compares categorical variables. Kaplan-Meier survival analysis was performed using SPSS.Results Of 48 patients, 31 were followed up by Cardiology, 17 by Geriatrics (median 4 times for both cohorts in 30 days, [IQR 3,4]). Patients were older with more comorbidities in the geriatrician cohort ( table 1). 53% of the geriatric cohort had HF with reduced ejection fraction (HFrEF), compared with 61% under cardiology.The primary outcome-DAWOH-was not significantly different between the cohorts (table 2). By one-year 29% (5/17) died in the Geriatric cohort vs 19% (6/31) under Cardiology (log rank p=0.47, figure 1).The geriatrician cohort were less likely to be on SGLT2i and ACEi/ARB/ARNI; high falls risk may limit medication titration. (Table 2) 20% fell in the last 12 months. They also weighed themselves fewer days(median 6 [0.5,27] v 16 [5,30], p=0.2).Conclusion Despite worse prognostic indicators (older, more comorbidities), the geriatrician cohort enjoy similar number of days alive and well out of hospital as patients under cardiology. Despite frailty and comorbidity burden, patients coped with intense follow-up.Abstract 395 Figure 1One-year survival (log rank p=0.47)Abstract 395 Table 1Baseline characteristicsGeriatrics (N= 17)Cardiology (N = 31)PAge80 [76,87]76 [65, 84]0.046Gender17 Female8 Female, 23 Male<0.001Co-morbidities in addition to HF10 (4)5 (3)<0.001Renal function (eGFR)37 [22,67]57 [34,82]0.059NT-Pro-BNP7487 [1982, 14607]6142 [1845,11580]0.76Rockwood Clinical Frailty Score4 [3.5,6]5 [3,5]0.50SystolicBlood Pressure116 [109, 141]114 [101,143]0.5AF7/17 (41%)14/31 (45%)1.0Aetiology(% ischaemic)8/17 (47%)13/31(42%)0.8Abbreviation- AF: atrial fibrillation; eGFR: estimated glomerular filtration rate; NT-Pro BNP: N-terminal pro B-type natriuretic peptideAbstract 395 Table 2Treatment and outcomesGeriatrics(N= 17)Cardiology(N = 31)PBlackpool HFrEF score, %35 (22)63 (20)0.003Blackpool HFpEF score, %0 [0,50]50 [0,100]0.4ACEi/ARB/ARNI7/17 (41%)22/29 (76%)0.028Beta blocker15/17 (88%)27/29 (93%)0.6MRA3/17 (18%)11/29 (38%)0.2SGLT2i6/17 (35%)21/28 (75%)0.03Days alive and well out of hospital (30 day follow up)30 [10,30]26 [14,30]0.7Abbreviations- Blackpool HFrEF score / Blackpool HFpEF score (at final visit):The Blackpool Heart Failure Medical Therapy Score helps assess Guideline Directed Medical Therapy use/dose titration.For Heart Failure with Reduced Ejection Fraction (HFrEF), the score allocates up to 2 points for Angiotensin-converting enzyme inhibitor (ACEi)/Angiotensin receptor blocker (ARB)/Angiotensin receptor–neprilysin inhibitor(ARNI) and for Beta-blocker (1 point if <50% max dose), 2 points for any dose of Mineralocorticoid receptor antagonist (MRA) and 2 points for any dose of Sodium-Glucose Co-Transporter 2 Inhibitors (SGLT2i). Use of Ivabradine (if heart rate ≥70 bpm in sinus rhythm) and hydralazine–isosorbide dinitrate (in Black patients) will score an extra 2 points each if >50% max dose (1 if <50% max dose), yielding a maximum of 12.Thus, a maximum score of 8-12 depends on ethnicity, heart rate and rhythm. Blackpool score is expressed as % of maximum score tailored to the patient.For HF with Preserved Ejection Fraction (HFpEF), the score includes 2 points each for MRA and SGLT2i (maximum 4).",
  "authors": [
    {
      "affiliations": [
        "Department of Care of Older People, Blackpool Victoria Hospital, Blackpool, United Kingdom"
      ],
      "name": "Suzanne Wong"
    },
    {
      "affiliations": [
        "Department of Cardiology, Blackpool Victoria Hospital, Blackpool, United Kingdom"
      ],
      "name": "Fatima Seedat"
    },
    {
      "affiliations": [
        "Department of Cardiology, Blackpool Victoria Hospital, Blackpool, United Kingdom"
      ],
      "name": "Ahmed Hassanien"
    },
    {
      "affiliations": [
        "Patient Public Involvement group for research and quality improvement, Lancashire Cardiac Centre, Blackpool, United Kingdom"
      ],
      "name": "Grace Wong"
    },
    {
      "affiliations": [
        "Department of Care of Older People, Blackpool Victoria Hospital, Blackpool, United Kingdom"
      ],
      "name": "Yee Mon"
    },
    {
      "affiliations": [
        "Department of Cardiology, Blackpool Victoria Hospital, Blackpool, United Kingdom"
      ],
      "name": "Mohammad Al-Riyahi"
    },
    {
      "affiliations": [
        "Department of Cardiology, Blackpool Victoria Hospital, Blackpool, United Kingdom"
      ],
      "name": "Mahendra Nehra"
    },
    {
      "affiliations": [
        "Department of Cardiology, Blackpool Victoria Hospital, Blackpool, United Kingdom"
      ],
      "name": "Ojasvi Sharma"
    },
    {
      "affiliations": [
        "Department of Cardiology, Blackpool Victoria Hospital, Blackpool, United Kingdom",
        "Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom"
      ],
      "name": "Kenneth Y-K Wong"
    }
  ],
  "title": "395 How does outcome of intensive follow-up by geriatrician compare with cardiology in acute heart failure?",
  "uid": "ccc41ecc-c0c9-52f8-85f0-aab5a5da8168"
}