Transformation of Heart Failure Care in Oman: Impact of Multidisciplinary Advanced Heart Failure Clinic on Patient Outcomes

Abstract

Background: Heart failure (HF) is a significant burden in Oman. The HF clinic at the Royal Hospital, established in 2014, was initially managed by one cardiologist and later by two in 2021. Limited resources, late referrals, and the absence of a dedicated advanced HF team led to suboptimal outcomes, with high re-admissions and poor survival. In early 2024, two advanced HF and transplant cardiologists joined, improving the service. 

Objective: To evaluate the impact of the enhanced HF service on patient outcomes, focusing on survival, re-admission, and management strategies.

Methods: A retrospective cohort study included all HF patients attending the clinic from 2014–2023. Data from the pre-enhancement period (2014–2023) were compared with post-enhancement (2024). Demographics, clinical characteristics, and outcomes were analysed using SPSS v22. Kaplan-Meier survival analysis assessed survival rates. Adherence to guideline-directed medical therapy (GDMT) was evaluated. Significance was set at p < 0.05.

Results: In 2014–2023, 2,940 patient visits were recorded (average 15/day; 55% ischemic cardiomyopathy; mean age 65; 60% male). Outcomes included:

• Re-admissions: 45%
• One-year survival: 60%
• GDMT adherence: 40%

In 2024, following service enhancement:

• Re-admissions: 30% (p = 0.02)
• One-year survival: 75% (p = 0.01)
• GDMT adherence: 70% (p = 0.03)
• Mean age: 64; 58% male
• 50% improved NYHA class (p = 0.02)
• Quality of life improved (MLHFQ, p = 0.03)
• Reduced exacerbations in patients with comorbidities (p = 0.04)

Kaplan-Meier analysis confirmed improved survival (log-rank p = 0.01).

Conclusion: Enhancement of the HF clinic through the addition of advanced HF cardiologists and a multidisciplinary approach significantly improved outcomes. Dedicated HF programs, early referral, and team-based care are vital to sustain these gains.