# Clinical Audit on Follow-Up Time of Patients Admitted With Acute Decompensated Heart Failure

## TL;DR

This study found that targeted interventions improved timely outpatient follow-up for heart failure patients after hospital discharge.

## Contribution

The study demonstrates the effectiveness of interventions in improving post-discharge follow-up compliance with international guidelines.

## Key findings

- Follow-up documentation at discharge increased from 75% to 96.67% after interventions.
- Compliance with 14-day follow-up improved from 53.33% to 91.67%.
- The mean follow-up interval decreased from 12.43 to 8.97 days.

## Abstract

Background: Early outpatient follow-up after hospital discharge is essential to reduce readmissions and improve outcomes in patients with acute decompensated heart failure (ADHF).

Objective: This audit aims to assess whether patients admitted with ADHF receive outpatient follow-up within 14 days of discharge, in line with international guideline recommendations.

Methodology: A prospective clinical audit was conducted at the Peshawar Institute of Cardiology, Pakistan, including 120 adult patients admitted with ADHF (60 in the initial audit and 60 in the re-audit). Patient demographics, planned and actual follow-up dates, the number of days between discharge and follow-up, attendance, and the kind of healthcare provider were all gathered from hospital admission records, discharge summaries, and outpatient clinic documents. Patients who passed away while in the hospital, were moved, released against medical advice, or had inadequate medical data were excluded. Following the first audit (March-May 2025), there was an intervention phase (June-July 2025) and a second audit (August-October 2025). Chi-square and paired t-tests were used to evaluate compliance with a 14-day follow-up (SPSS version 25, IBM Corp., Armonk, NY).

Results: The mean age was 64.27 ± 11.76 years (initial audit) and 65.12 ± 10.45 years (re-audit), with 38 (63.33%) male patients initially and 36 (60%) in the re-audit. Follow-up documentation at discharge increased from 45 patients (75%) to 58 patients (96.67%). Compliance with 14-day follow-up improved from 32 patients (53.33%) to 55 patients (91.67%), follow-ups after 14 days decreased from 18 (30%) to three (5%), and non-attendance dropped from 10 (16.67%) to two (3.33%). The mean follow-up interval reduced from 12.43 ± 5.12 days to 8.97 ± 2.85 days.

Conclusion: Targeted interventions significantly improved timely post-discharge follow-up in patients with ADHF.