Key result
Multidisciplinary HFOC follow-up is linked to ~34% lower 1-year mortality or readmission in HFrEF.
Why the study?
Although guidelines recommend enrolling all HF patients in a multidisciplinary management programme to improve prognosis, the accessibility of HF Outpatient Clinics in real-world practice remains suboptimal and their effect alongside modern guideline-directed medical therapy needed evaluation.
Does multidisciplinary follow-up at a Heart Failure Outpatient Clinic reduce the composite of 1-year all-cause mortality or heart failure hospitalization in patients discharged after hospitalization for HFrEF?
Cohort (n=551)
No
Does multidisciplinary follow-up at a Heart Failure Outpatient Clinic reduce the composite of 1-year all-cause mortality or heart failure hospitalization in patients discharged after hospitalization for HFrEF?
Real-world propensity-matched data demonstrate that multidisciplinary Heart Failure Outpatient Clinic follow-up after HFrEF hospitalization significantly increases 1-year quadruple GDMT utilization and reduces 1-year mortality or heart failure rehospitalization by 34.5%.
Answers are grounded in this paper and cite their sources.
HFOC follow-up was associated with fewer 1-year events after HFrEF discharge; supports ESC multidisciplinary recommendations but requires RCT confirmation.
Introduction The 2021 European Society of Cardiology (ESC) Heart Failure (HF) Guidelines (GLs) recommend enrolling all HF patients in a multidisciplinary HF management programme to improve the prognosis. However, the accessibility of HF Outpatient Clinics (HFOCs) in real-world clinical practice remains suboptimal. Aims To assess the real-world effect of multidisciplinary follow-up (FUP) at an HFOC on the composite endpoint of 1-year all-cause mortality (ACM)/HF hospitalisation (HFH) in a consecutive cohort of patients after a hospitalisation for HF with reduced ejection fraction (HFrEF), using propensity-score matching (PSM) analysis in light of the modern GL-directed medical therapy (GDMT). Patients and methods The data of a consecutive group of 551 patients (male: 75%, age: 63 [52-71] years, de novo HF: 42%, LVEF: 25 [20-30]%, coronary artery disease: 45%, hypertension: 68%, diabetes: 40%, eGFR < 60 mL/min/1.73m2: 52%, NT-proBNP at hospital admission: 5866 [2728-10616] pg/mL, GDMT at discharge: RASi/target doses [TD] of RASi: 94%/18%, βB/TD βB: 85%/7%, MRA/TD MRA: 95%/64%, SGLT2i: 68%, triple therapy [TT: RASi + βB + MRA]/TD TT: 82%/2%, quadruple therapy [QT: TT + SGLT2i]/TD QT: 61%/2%, CRT-P/CRT: 13%, ICD without CRT-D: 13%) hospitalised for HFrEF between 2021 and 2025 at our cardiology centre were analysed. Patients followed up at our HFOC were matched in a 1:1 ratio with patients not followed up at our HFOC using the nearest neighbour matching method with adjustment for possible confounders at hospital discharge (female sex, age, de novo HFrEF, coronary artery disease, atrial fibrillation, diabetes, hypertension, systolic blood pressure, heart rate, creatinine-, potassium-, haemoglobin level, LVEF, CRT, RASi-, βB-, MRA-, SGLT2i medication). In the PSM cohort, the composite endpoint of 1-year ACM/HFH was examined, as was the GDMT application rate at 1 year. Results In the total cohort, the composite of 1-year ACM/HFH occurred in 28% of patients (ACM: 16%, HFH: 18%). In the PSM cohort (n=332), 1-year ACM/HFH affected 23% of the HFOC patients and 33% of the non-HFOC patients. FUP at the HFOC was accompanied by a 34.5% relative risk reduction of ACM/HFH (adjusted HR: 0.655, 95% CI: 0.434-0.987, p=0.043) even within 1 year. At 1 year, 76% of the total cohort received TT (TD TT: 9%), while 60% had QT (TD QT: 7%). Evaluating GDMT in the PSM subgroup, at 1-year follow-up, HFOC patients were significantly more frequently treated with QT (67% vs 53%, p=0.038; HFOC vs non-HFOC) and TD MRA therapy (64% vs 51%, p=0.022; HFOC vs non-HFOC), while a trend was observed in the TD QT use (10% vs 4%; HFOC vs non-HFOC; p>0.05). Conclusions Our real-world PSM analysis confirmed that FUP at a multidisciplinary HFOC after hospitalisation for HFrEF can reduce the risk of ACM/HFH within 1 year by 34.5%. Besides, the complex care at an HFOC improved in the long-term the application of GDMT, with a significantly higher QT application rate.MB HOFC PSM prognosisMB Pharmacotherapy
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Muk et al. (2026) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=551). Multidisciplinary Heart Failure Outpatient Clinic (HFOC) follow-up vs. No follow-up at the Heart Failure Outpatient Clinic (non-HFOC) was evaluated on Composite of 1-year all-cause mortality (ACM) or heart failure hospitalization (HFH) (HR 0.655, 95% CI 0.434-0.987, p=0.043). Multidisciplinary HFOC follow-up after HFrEF hospitalization reduced 1-year all-cause mortality or HF hospitalization vs non-HFOC care (23% vs 33%; HR 0.655, 95% CI 0.434-0.987, p=0.043).
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