Assessing the impact of heart failure specialist services on patient populations

Statistical modelling of prevented or postponed events among previously hospitalised patients, using estimates of: treatment uptake and contraindications (based on local audit data); treatment effectiveness and intolerance (based on literature); and annual number of hospitalization per patient and annual risk of death (based on routine data).Optimal treatment uptake among eligible but untreated patients would over one year prevent or postpone 11% of all expected readmissions and 18% of all expected deaths for spironolactone, 13% of all expected readmisisons and 22% of all expected deaths for b-blockers (carvedilol) and 20% of all expected readmissions and an uncertain number of deaths for N-LEI. Optimal combined treatment uptake for all three interventions during one year among all eligible but untreated patients would prevent or postpone 37% of all expected readmissions and a minimum of 36% of all expected deaths.In a population of previously hospitalised patients with low previous uptake of b-blockers and no uptake of N-LEI, optimal combined uptake of interventions through specialist heart failure services can potentially help prevent or postpone approximately four times as many readmissions and a minimum of twice as many deaths compared with simply optimising uptake of spironolactone (not necessarily requiring specialist services). Examination of the impact of different heart failure interventions can inform rational planning of relevant healthcare services.Heart failure has a survival rate worse than for many common cancers [1,2] and is responsible for 4% of all UK deaths [3]. Hospital admissions are frequent [4-6], partly preventable [7], and costly [8]. Apart from Angiotensin Converting Enzyme (ACE) inhibitors or Angiotensin 2 (A2) antagonists, medical treatments reducing mortality and readmissions in heart failure due to Left Ventricular Systolic Dysfunction (LVSD) include b-blockers [9], and, in New York Heart Association (NYHA) class III/IV patients, spiron