Ambulatory Outpatient Management of Acute Decompensated Heart Failure in a Heart Failure Specialist Nurse Delivered Unit

AIMS: This study compares the outcomes of adult patients with acutely decompensated heart failure(ADHF) treated with intravenous(IV) diuretics in an inpatient setting versus outpatient management in heart failure specialist nurse delivered, consultant-led ambulatory acute heart failure unit(AHFU). METHODS & RESULTS: A single-centre retrospective observational cohort study of 3713 patients with acute HF was conducted from January 2016 to December 2022. Hospitalised patients treated for ADHF with IV diuretics(Standard Care-SC, n=2483) were compared to those treated with bolus IV diuretics in an outpatient specialist AHFU(n=1230). Propensity score matching(PSM) was used to adjust for baseline differences across 11 covariates, resulting in two evenly matched cohorts of 1,227 patients in each arm. Before PSM, significant differences were observed between the SC and AHFU cohorts. The SC cohort was older(mean age 76.8 vs 75.0; p≤0.001), had a higher clinical risk score(GWTG 43.35±11.38 vs. 42.37±12.02; p=0.016), greater frailty(CFS 5.23±1.14 vs. 5.16±1.01;p=0.007), elevated NTproBNP levels, higher ejection fraction(43.35%±11.38 vs. 42.37%±12.02; p=0.016), and a higher prevalence of comorbidities(CCI 7.44±1.87 vs. 7.3±1.73; p=0.021). After matching, the cohorts were comparable across all covariates. The AHFU group showed significantly lower readmission rates at 30 days(16.5% vs. 24.1%,p<0.001) and 1 year(25.2% vs. 30.8%,p=0.004) compared to the SC group. The AHFU group had lower 30-day mortality(10.1%vs.13.5%, p=0.009), but there was no significant difference in 1-year mortality(10.9%vs.10.8%,p=>0.999) was seen. CONCLUSION: Our propensity score-matched analysis demonstrates that HF specialist nurse-delivered, consultant-led AHFU care can improve 30-day mortality and readmission rates, as well as 1-year readmission outcomes. This model may serve as an alternative to hospitalisation for suitable patients.