IMPACT OF A MULTIDISCIPLINARY TEAM IN THE MANAGEMENT OF SUBJECTS WITH HEART FAILURE
Nicole DeLalla, Athena Colon, Richard Lane, Reginald Leandre, Tracey Dobbs
AdventHealth Apopka – AdventHealth Apopka, Florida, FL
Background: In 2024, nearly seven million individuals in the United States were diagnosed with heart failure.1,2 The resulting healthcare-related expenditure for treatment of this disease state has been calculated at over $3 million.1,2 In order to improve clinical outcomes, studies have shown that guideline-directed medical therapy (GDMT) can increase survival rates by 6.3 years. Additionally, GDMT has the potential to alleviate financial burden as a single heart failure-related hospitalization can cost about $15,000. 3,4 A study by Fallon and colleagues found that taking an interdisciplinary approach to heart failure management resulted in a 6% decrease in 30-day recurrent admissions in this patient population.5 However, there are limited studies focusing on how inpatient interventions affect rehospitalizations.
Methods: This was a single-center, retrospective chart review conducted at AdventHealth Apopka between July 1st, 2024 to December 31st, 2024. Included subjects were 18 years of age or older with a diagnosis of heart failure with reduced ejection fraction (HFrEF), defined as ejection fraction (EF) less than 40%. The exclusion criteria were subjects with an EF of 40% or greater, a history of a heart transplant, or planned heart transplant at the time of index visit. The primary objective was to assess the impact of a multidisciplinary heart failure management team on 30-day readmission rates. Secondary objectives included 30-day cardiovascular-related readmission, 30-day all-cause mortality, dose optimization defined as dose titration of GDMT medications or addition of at least one GDMT medication drug class, and inpatient length of stay (LOS). In addition, safety outcomes evaluated were incidence of acute kidney injury (AKI), hypotension, bradycardia, and hyperkalemia.
Results: A total of 904 subjects were reviewed. Among those patients 146 subjects were included while 758 subjects were excluded. Baseline characteristics showed mainly white/Caucasian males with an average age was 67 years old. The 30-day readmission rates among the included patients were 33%. The 30-day cardiovascular readmission rate was 14%, and the 30-day all-cause mortality rate was 7%. Beta blockers had the highest incidence of dose titration at 17 %. The highest incidence of GDMT initiation was both beta blocks and diuretics with 27%. The average LOS was about 4.92 days.
Conclusion: In conclusion, this study saw a readmission rate of 33% after a multidisciplinary heart failure management team. When compared to national readmission rate of 25%, there is an eight percent difference in readmission rates to this study.6 This would suggest that there are areas of opportunities to further development of this heart management team.
References
HF stats 2024: Heart Failure Epidemiology and ... Accessed February 25, 2025. https://onlinejcf.com/article/S1071-9164(24)00232-X/fulltext.
- Centers for Disease Control and Prevention. Heart Failure. CDC. https://www.cdc.gov/heart-disease/about/heart-failure.html. Published October 14, 2022. Accessed September 11th, 2024
- Martin SS, Aday AW, Almarzooq ZI, et al. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association [published correction appears in Circulation. 2024 May 7;149(19):e1164. doi: 10.1161/CIR.0000000000001247]. Circulation. 2024;149(8):e347-e913. doi:10.1161/CIR.0000000000001209
- Weiss AJ, Jiang HJ. Overview of Clinical Conditions With Frequent and Costly Hospital Readmissions by Payer, 2018. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); July 20, 2021.
- Fallon JM, Anderson K, McElhaney E, Lewis DA, Williams JB. Pharmacy-led optimization of transitions of care in patients with heart failure. J Am Coll Clin Pharm. 2024;7(6):778-786. doi:10.1002/jac5.1982.
Foroutan F, Rayner DG, Ross HJ, et al. Global comparison of readmission rates for patients with heart failure.
Journal of the American College of Cardiology. 2023;82(5):430-444. doi:10.1016/j.jacc.2023.05.040
