Introduction Heart failure (HF) mortality rates continue to pose a significant challenge despite advancements in recent decades – in the UK, one-year mortality rates are approximately 20%, ranging up to 30% globally among HF patients.1, 2 Of note, elderly individuals, a substantial segment of the HF population, face particularly high one-year mortality rates.3

Reduced left ventricular ejection fraction (EF) is a key prognostic element in HF, and so a target for intervention.4, 5 The strategic introduction and uptitration of evidence-based HF medications, encompassing angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin receptor neprilysin inhibitor (ARNI), ß-blockers (BB), mineralocorticoid receptor antagonists (MRA), and SGLT-2 inhibitors (SLGT2i), constitutes an opportunity for treatment.6 Despite these interventions, difficulties persist in timely and efficient drug deployment. Previously, in a smaller cohort of 73 patients, we have shown that Consultant-supervised nurse-led HF clinics (CoNHFCs) offer a viable method of early initiation and uptitration of medications, leading to significant improvements in ejection fraction.7

Aims To assess the impact of early initiation and uptitration of evidence-based HF medications through CoNHFCs on one-year mortality rates in patients with heart failure with reduced (HFrEF) and mildly reduced ejection fraction (HFmREF).

Methods Data was obtained from electronic patient records of HFrEF and HFmrEF patients who attended a minimum of two CoNHFCs between 21/2/2021 and 23/2/2023. Information collected included demographics, comorbidities, baseline and follow-up EFs, prescribed HF drugs and doses, as well as mortality within the first year after initial CoNHFC attendance.

Results One hundred and nine patients were included. The mean age was 61 years, 69.7% were male. The one-year mortality rate following initial CoNHFC attendance was 3.7%. For patients aged ≥70 years and ≥80 years, one-year mortality rates of 6.5% and 11.1% were recorded, respectively.

Additionally, significant improvements were seen in pharmacotherapy and ejection fractions of this expanded cohort, consistent with our prior findings.7 Ejection fraction increased significantly from an average of 31.0% (+/-8.8) to 40.1% (+/-10.7) (p<0.05) before vs after attending CoNHFCs.

Comparing HF pharmacotherapy at the initial visit to the last, the percentage of the cohort prescribed prognostic HF drugs – BB, ACE-I/ARB, MRA, ARNI, and SGLT2i – stood at 83.5% vs 92.7%, 70.6% vs 38.6%, 38.6% vs 61.5%, 9.2% vs 54.1%, and 16.5% vs 68.8%, respectively. Patients prescribed all four ’pillar’ HF drugs increased from 10.1% to 40.4%, the proportion prescribed three ’pillar’ drugs rose from 35.8% to 77.1%.

Conclusion Early introduction and uptitration of the four pillars of HF medications through consultant-supervised nurse-led clinics led to one-year mortality rates substantially lower than those previously reported in national and international studies.1, 2

Conflict of Interest None