3 Analysis of care pathways in patients admitted with acute decompensated heart failure (ADHF) shows a missed opportunity during the prehospital period to minimise the risk of admission

Introduction Heart failure (ADHF) admission rates remain a major challenge. There is a paucity of data available relating to the pre-hospital phase of care prior to admission with ADHF. We aimed to achieve a more complete understanding of this period, which may allow for more effective pre-hospital intervention thereby preventing admission. Method In an ongoing study analysing care pathways in patients admitted to St. Vincent’s University Hospital with ADHF (de novo presentations, DN, and recurrent admitters, RA), focus was placed on the pre-hospital period to assess duration of symptoms, seeking of pre-hospital medical assessment, the nature of any intervention heart failure-directed (HFI) or otherwise and, in the case of RA, the effectiveness in reporting weight gain. This interim analysis includes 50 patients. Data was gathered from clinical patient surveys, conducted by a heart failure nurse specialist and completed by the patient and a designated family member. Result Of a total of 50 patients, 30 (60%) were DN and 20 (40%) were RA. Median years since HF diagnosis for RA was 4.5 years. Median age was 72 years (69 for DN, 76 for RA). RA had a higher number of co-morbidities (4.5) compared to DN (3). More than 75% of patients in both groups reported a symptom duration of u003e3 days. Of RA, 90% (18) reported monitoring their weight and 72.22% (13 of 18) of those noted a weight gain of Conclusion Due to the prolonged duration of symptoms and the high rate of patients seeking medical advice in the community, there is both time and opportunity in which to implement a more effective HFI during the pre-hospital phase of care for patients presenting with ADHF. Improved patient education and improved recognition of HF features by GP’s with streamlined access to outpatient specialist assistance may allow for earlier appropriately directed HFI, potentially reducing the risk of admission.