{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T22:30:14Z","timestamp":1777501814549,"version":"3.51.4"},"reference-count":9,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,5,8]],"date-time":"2020-05-08T00:00:00Z","timestamp":1588896000000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2020,3,27]]},"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Assessing the impact of a new integrated heart failure service (IHFS) in a medium-sized district general hospital (DGH) on heart failure (HF) mortality, readmission rates, and provision of HF care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A retrospective, observational study encompassing all patients admitted with a diagnosis of HF over two 12-month periods before (2012\/2013), and after (2015\/2016) IHFS establishment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Total admissions for HF increased by 40% (385 vs 540), with a greater number admitted to the cardiology ward (231 vs 121). After IHFS implementation, patients were more likely to see a cardiologist (35.1% vs 43.7%, p=0.009), undergo echocardiography (70.1% vs 81.5%, p&lt;0.001), be initiated on all three disease modifying HF medications (angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB) and mineralocorticoid receptor antagonists (MRA)) in the heart failure with reduced ejection fraction (HFrEF) group (42% vs 99%, p&lt;0.001) and receive specialist HF input (81.6% vs 85.4%, p=0.2). Both 30-day post-discharge mortality and HF related readmissions were significantly lower in patients with heart failure with preserved ejection fraction (HFpEF) (8.9% vs 3.1%, p=0.032, 58% reduction, p=0.043 respectively) with no-significant reductions in all other HF groups. In-patient mortality was similar. Length of stay in Cardiology wards increased from 8.4 to 12.7 days (p&lt;0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Establishment of an IHFS within a DGH with limited resources and only a modest service re-design has resulted in significantly improved provision of specialist in-patient care, use of HFrEF medications, early heart failure nurse follow-up, and is associated with a reduction in early mortality, particularly in the HFpEF cohort, and HF related readmissions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2019-001218","type":"journal-article","created":{"date-parts":[[2020,5,11]],"date-time":"2020-05-11T06:11:25Z","timestamp":1589177485000},"page":"e001218","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["The impact of an integrated heart failure service in a medium-sized district general hospital"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0422-9147","authenticated-orcid":false,"given":"Alasdair","family":"Hawley","sequence":"first","affiliation":[{"name":"Cardiology, Torbay and South Devon NHS Foundation Trust, Torquay, Devon, UK"},{"name":"Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingzhou","family":"He","sequence":"additional","affiliation":[{"name":"Cardiology, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Crabtree","sequence":"additional","affiliation":[{"name":"Medicine, Torbay and South Devon NHS Foundation Trust, Torquay, Torbay, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stelios","family":"Iacovides","sequence":"additional","affiliation":[{"name":"Cardiology, Torbay and South Devon NHS Foundation Trust, Torquay, Devon, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phil","family":"Keeling","sequence":"additional","affiliation":[{"name":"Cardiology, Torbay and South Devon NHS Foundation Trust, Torquay, Devon, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,5,10]]},"reference":[{"key":"2025081709363456000_7.1.e001218.1","doi-asserted-by":"publisher","DOI":"10.1136\/heart.83.5.505"},{"key":"2025081709363456000_7.1.e001218.2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm102"},{"key":"2025081709363456000_7.1.e001218.3","first-page":"329","article-title":"Management of chronic heart failure in the older population","volume":"11","author":"Azad","year":"2014","journal-title":"J Geriatr Cardiol"},{"key":"2025081709363456000_7.1.e001218.4","unstructured":"British Society for Heart Failure . National heart failure audit (April 2014-March 2015). Available: https:\/\/www.ucl.ac.uk\/nicor\/audits\/heartfailure\/documents\/annualreports\/heartfailurepublication14_15 [Accessed 28 Nov 2016]."},{"key":"2025081709363456000_7.1.e001218.5","unstructured":"Torbay Hospital CQC report. Available: https:\/\/www.cqc.org.uk\/location\/RA901\/reportsort"},{"key":"2025081709363456000_7.1.e001218.6","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1111\/1753-6405.12762","article-title":"Socioeconomic status and multimorbidity: a systematic review and meta-analysis","volume":"42","author":"Pathirana","year":"2018","journal-title":"Aust N Z J Public Health"},{"key":"2025081709363456000_7.1.e001218.7","unstructured":"National Institute for Health and Care Excellence (NICE) . Management of chronic heart failure in adults in primary and secondary care, 2010. Available: https:\/\/wwwniceorguk\/guidance\/cg108\/resources\/guidance-chronic-heart-failure-pdf"},{"key":"2025081709363456000_7.1.e001218.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2017.05.011"},{"key":"2025081709363456000_7.1.e001218.9","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw128"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2019-001218","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T16:36:43Z","timestamp":1755448603000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2019-001218"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,5,10]]},"published-print":{"date-parts":[[2020,5]]}},"alternative-id":["10.1136\/openhrt-2019-001218"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2019-001218","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5]]}}}