33 Prospective descriptive analysis of outpatient presentation of worsening heart failure

BackgroundHeart failure (HF) is a leading cause of morbidity and mortality globally. Up to date research has shown the strong link between HF hospitalization with poor outcomes1. Although HF management has evolved significantly in recent years, worsening heart Failure (WHF) events are still challenging to overcome. HF outpatient clinics play major role in not only providing care but also the understanding of these events.AimsWe sought to analyse WHF events occurring in an outpatient HF cohort and identify patient factors which may have contributed to their acute presentations.MethodsA prospective observational analysis of HF outpatient clinic, with detailed study of WHF patients receiving appropriate guideline-directed medical therapies. Those events were captured between August 2022 and April 2023. Characteristics of WHF presentation are: the existence of at least one HF symptom and at least one physical sign of HF, or patients not meeting the previous definition but considered to have WHF event based on the clinical judgment of the managing physician. Regardless, up-titration of diuretic therapy must be present in both. Presentations were subdivided WHF diagnosed during scheduled visits (routine) and unscheduled visits (acute).Results140 patients were identified within the study period, 53.5% of male gender and median age of 80 years. Unscheduled visits are 39.2% of total WHF encounters seen, and out of those events, 49% were made by the caregiver rather than the patient. Scheduled visits which are the result of HF team recognizing WHF events constituted 60.8% of total encounters (figure 1). Patients presenting in an unscheduled manner were more likely to have dyspnoea at rest as their predominant symptom (72% vs 60%). WHF events occurring within 3 months of heart failure hospitalisation are predominately presented as scheduled visits 41% vs 18% (figure 2). Both groups shared a similar presentation of the following: prolonged duration of symptoms prior to HF visit (>7 days), low rate of following the advised instructions of home weight monitoring and more likely not to be at optimal doses of guideline-directed medical therapy GDMT (table 1).Abstract 33 Figure 1Abstract 33 Figure 2Abstract 33 Table 1 Scheduled Unscheduled Weight monitoring 49% 34% >7 days symptoms duration 72.9% 65.4% On optimal GDMT 27.2% 31% ConclusionDespite patient education around self-care and warning signs of WHF, a large proportion of patients did not present themselves for assess