HK study: Intensive postdischarge treatment improves HF outcomes

The REDUCE-HF ambulatory ser­vice model of intensive treatment fol­lowing hospital discharge from acute heart failure (HF) is shown to improve patients’ outcomes at 3 months.

Between October 2022 and De­cember 2023, researchers from the Prince of Wales Hospital (PWH) and Chinese University of Hong Kong (CUHK) recruited 245 postdischarge acute HF patients (mean age, 67.8 years; male, 72.2 percent; reduced left ventricular ejection fraction [LVEF] [ie, ≤40 percent], 60 percent; isch­aemic cardiomyopathy, 28 percent) into the nonrandomized, prospective REDUCE-HF study. Recruited patients were managed in an ambulatory HF centre within 2 weeks. Intensive treat­ment provided under the ambulatory REDUCE-HF service model included rapid uptitration of guideline-directed medical therapy (GDMT) and close follow-up, similar to the strategy adopt­ed in the STRONG-HF trial. [Kam K, et al, ESC 2024; Lancet 2022;400:1938- 1952]

The REDUCE-HF patients were followed up for 3 months to evaluate all-cause mortality and HF hospital­ization (primary outcomes), as well as clinical and functional status (second­ary outcomes).

Compared with a historical co­hort of 6,867 patients with a primary diagnosis of acute HF who received usual care between 2018 and 2022, patients in the REDUCE-HF cohort had a significantly lower rate of all-cause mortality (2.5 vs 9.3 percent; hazard ratio [HR], 0.26; 95 percent confidence interval [CI], 0.18–0.41; p<0.001) and a significantly lower in­cidence of HF hospitalization (8.6 vs 13.1 percent; HR, 0.65; 95 percent CI, 0.55–0.74; p<0.01) at 3 months.

Patients in the REDUCE-HF co­hort also showed significant 45.2 percent reduction in N-terminal pro– B-type natriuretic peptide levels (from 4,229 pg/mL at baseline to 2,319 pg/ mL at 3 months; p<0.001), significant increase in LVEF (from 39 to 44 per­cent; p<0.05), as well as significant improvements in 6-minute walk test (from 211 to 250 m; p<0.001) and Kansas City Cardiomyopathy Ques­tionnaire score (from 55.1 to 86.7; p<0.001).

“The positive outcomes were at­tributed to good adherence to GDMT, with adherence rates of 91 percent for angiotensin receptor-neprilysin inhibitor/angiotensin-converting en­zyme inhibitors/angiotensin-receptor blockers, 90.3 percent for beta-blockers, 95.5 percent for sodium-glucose cotransporter-2 inhibitors, and 72.4 percent for mineralocorticoid re­ceptor antagonists,” reported Dr Kevin Kam of CUHK’s Division of Cardiology.

“The REDUCE-HF ambulatory ser­vice model for postdischarge HF pa­tients is effective in reducing mortality, decompensation and unnecessary HF hospitalization. By intervening proac­tively, this model not only enhances patients’ quality of life, but also holds promise in alleviating the burden of in­patient HF services,” Kam concluded.