The clinical prognosis of elderly patients with decompensated congestive heart failure greatly improved for 7 years after introduction of our unique clinical pathway
Authors: Takaishi A , Endo T , Oomaru H , Kisinoue T , Mori H , Yamaji T , Tanimoto M , Onishi N , Suyama T , Ueeda M 
Published: November 2023

Abstract

Background
In Japan, especially in rural areas where our facility is located, the number of elderly decompensated congestive heart failure(DCHF) cases is increasing remarkably. Their hospitalization period tends to prolonged due to various complications peculiar to the elderly, and after discharge, they often admit in a short period with DCHF. In August 2015, we introduced the clinical pathway (PATH), which stipulates the efficient medical care for DCHF and comprehensive patient education by multidisciplinary staff. We have previously reported its effect about wide shortening of mean hospitalization period and significant reduction of rehospitalization in CHF patients admitted to our hospital.

Purpose
In this study, we re-examined the short-term and long-term clinical effects of PATH in elderly DCHF patients for 7 years, and also considered the residual problems about them.

Methods
We enrolled 929 DCHF cases (1128 admissions) aged 75 years or older who ware admitted to our hospital from April 2014 to July 2022. We divided them into two groups: 152 cases(199 admissions) admitted before the introduction of PATH (N-group) and 667 cases(929 admissions) applied PATH (P-group). About two groups we compared the acute care situation for DCHF, mean hospitalization period(HP), and DCHF readmission rate within 1 year after discharge(RA).

Results
The mean age of the P-group was slightly older. There were no significant differences between the two groups in the living conditions before admission, the proportion of each underlying disease or clinical data at admission. The performance rate of each treatment procedure in the acute phase was lower, and these performance period ware all shorter in P-group. The introduction rate of cardiac rehabilitation was higher and start timing was earlier in P-group. (Figure1) As a result, HP was significantly shorter), and the RA rate was lower in P-group. However, even in P-group, the cases who could not be discharged from the hospital to home(OTHER-group) took more time to adjust for hospital transfer or nursing home admission, so their HP was longer than that of the cases who could be directly discharged to home(HOME-group). And the RA rate of cases with past history of hospitalization for DCHF(PH-group) was higher than that of cases without history(NPH- group). (Figure2)

Conclusion
In the 7 years after the introduction of unique clinical pathway for acute phase treatment of decompensated congestive heart failure, even in elderly patients, it confirmed that each acute phase treatment had become more efficient, and the mean hospitalization period had been widely shortened. In addition, comprehensive lifestyle guidance to prevent worsening of their condition has seemed to reduce the rehospitalization rate for heart failure after discharge. However, we also confirmed f a few residual problems to be solved about the cases who could not discharged at home for any reason or repeated re-admission for heart failure.Figure 2