Abstract 12159: Titrating Management for Typically Older Patients With Chronic Heart Failure Management Using a Holistic, Traffic-Light Tool: The Which Heart Failure Intervention is Most Cost-Effective in Reducing Hospital Stay (WHICH?) II Trial

Background: The worldwide burden of chronic heart failure (CHF) continues to rise. In Australia there are >40,000 primary hospitalizations (>300,000 days) and 47,000 secondary hospitalizations (~ 700,000 days), 51% of which involve typically older women. Methods: To explore the potential value of titrating nurse-led CHF management relative to individual need (compared to a “one-size fits all” strategy) we initiated the multicentre WHICH? II Trial (target >1000 subjects). Using a validated tool, the Green Amber Red Delineation of Individual of risk And Need (GARDIAN), we assess 3 domains (holistic profile, management relative to gold-standard and clinical stability) to determine risk of premature mortality and recurrent hospitalization within 12 months. Results: Of 202 initially randomized subjects (mean age 70±11 years), 64 (36%) are female, 29 (14%) live in a regional setting and 56 (28%) have preserved ejection fraction. Based on GARDIAN profiling, 71% are very high risk (red), 19% medium risk and 10% are low risk subjects. Common markers of high risk status at index hospitalization are aged >75 years (59%); sex-specific anemia (42%); cognitive impairment ± self-care issues (37%); English as a second language ± moderate to severe renal dysfunction (34%); acute pulmonary edema on presentation (32%); extended hospital stay (30%); and intensive care stay (20%). Post-discharge, 30% have overt clinical instability and 28% elevated BNP (> 600pg/mL) within 7-14 days. Within the trial intervention group, subjects designated as high risk are subject to incremental home visits and more structured telephone support relative to low risk cases. As a broadly representative cohort of individuals with CHF, these data suggest that ~25,000 high risk patients with CHF are discharged from an Australian hospital each year; often with residual social, management and clinical issues that may respond to more intensive and individualized follow-up. Conclusions: These data reinforce the potential to alter the intensity of nurse-led, multidisciplinary management to cost-effectively improve outcomes in a sub-set of CHF cases at very high risk of poor health outcomes. Any positive results from the trial will be immediately applicable to whe wider CHF patient population.