APPLYING THE ACC STANDARDS TO IMPROVE THE QUALITY OF HEART FAILURE TREATMENT AT VINMEC

I. REASON FOR IMPLEMENTING THE PROJECT

The prevalence of heart failure in the Southeast Asia region is significantly higher than the rest of the world (4.5–6.7% compared to 0.5–2%) [1]. In the case of cardiac hospitals in Vietnam, heart failure patients account for 15% of total admissions, with a readmission rate within 30 days after discharge rising up to 7% [2].

There exist several challenges in managing patients with heart failure in Vietnam:

• Lack of heart failure screening programs.
• Lack of post-discharge monitoring programs.
• Insufficient data on treatment outcomes for heart failure.
• Insufficient data on monitoring compliance with domestic and international treatment guidelines.

In that context, Vinmec Times City International Hospital and Vinmec Central Park International Hospital have taken the lead in establishing a Heart Failure Management Program, which follows the Integrated Practice Unit (IPU) model in accordance with the quality standards of the American College of Cardiology (ACC). The aim of the program is to improve the overall quality of heart failure treatment.

II. TARGETS

Vinmec Hospital has applied the ACC standards in the management of heart failure to enhance the quality of treatment. The specific improvements include:

• Reducing the average length of hospital stay to below 4 days.
• Ensuring no readmissions due to heart failure within the 30 days post-discharge.
• Reducing the rate of complications associated with kidney function decline during inpatient treatment and improving the quality of treatment outcomes assessed through Patient-Reported Outcome Measures (PROM).
• Decreasing the costs associated with the treatment of heart failure during inpatient care.

III. IMPROVEMENT SOLUTIONS

PHASE 1. PROGRAM DEVELOPMENT (01/2022 – 03/2022)

Establishing a multidisciplinary team for heart failure management (IPU).

Formulating specialty documents in adherence to ACC guidelines, including emergency and inpatient heart failure pathways, training materials, and assessment checklists.

PHASE 2. IMPLEMENTATION AND ASSESSMENT (04/2022 – 10/2022)

Training for physicians and nurses, aimed at standardizing their knowledge and practical skills in accordance with specialized protocols for the management of heart failure

Constructing health education materials for heart failure patients and deliver the materials to individuals affected by the condition.

Conducting quarterly cost-free cardiovascular health counseling sessions and screening for heart diseases in Hanoi and Ho Chi Minh City.

PHASE 3: ACCREDITATION AND CONTINUED SUSTAINABILITY (11/2022-PRESENT)

IV. RESULTS

1. Average length of hospital stay

2. Rate of readmission due to heart failure within the 30 days post-discharge (%)

The readmission rate for heart failure within 30 days after discharge decreased to 0% at both Vinmec Times City (VMTC) and Vinmec Central Park (VMCP).

3. Rate of complications associated with kidney function decline (%)

The complication rates related to kidney function decline in heart failure patients noticeably decreased at both hospitals.

4. Mortality rate for heart failure within 30 days post-discharge (%)

The implementation of the ACC standards directly contributed to the significant decrease in the mortality rate for heart failure within 30 days post-discharge at VMCP and sustainment of no 30-day post-discharge mortality cases at VMTC.

5. Quality of life of heart failure patients according to KCCQ score

• The indicators related to the quality of life of heart failure patients all improved after 3 months of treatment.
• The most noticeable improvement was in symptom scores, including reduced leg swelling, fatigue, and shortness of breath.

6. Impact on treatment costs

The average inpatient treatment costs for heart failure patients during the implementation period (in 2022) decreased by 30% compared to the average cost calculated for the period before the ACC standards were implemented (in 2021).

V. CONCLUSION

The Vinmec Healthcare System’s Heart Failure Management Program, in accordance with the reputable standards of the American College of Cardiology (ACC), has enhanced the quality of treatment and care for heart failure patients. The improvement is shown by the following outcomes:

• A decrease in the average length of hospital stay to below 4 days.
• A reduction in the readmission rate for heart failure within 30 days post-discharge down to 0%.
• A decrease in the incidence of renal function decline.
• An improved quality of life in heart failure patients.
• A decrease in the treatment costs.

These results helped Vinmec Times City and Vinmec Central Park become the first hospitals in Asia to obtain ACC certification in Heart Failure Management. The Cardiovascular Centers of both hospitals are recognized as the first Centers of Excellence in Cardiology in Asia, officially accredited by the ACC in November 2022.

We believe that, given these promising results, other hospitals in Vietnam can learn from and apply ACC standards to enhance the quality of care and treatment, particularly for heart failure patients, and more broadly, for cardiac patients.