Multidisciplinary Heart Failure Research Articles

Long-term clinical outcomes and healthcare resource utilization in male and female patients following hospitalization for heart failure.

Heart failure (HF) is a leading cause of hospitalization, and sex differences in care have been described. We assessed sex-specific clinical outcomes and healthcare resource utilization following hospitalization for HF. This was an exploratory analysis of patients hospitalized for HF across 10 Canadian hospitals in the Patient-Centered Care Transitions in HF (PACT-HF) cluster-randomized trial. The primary outcome was all-cause mortality. Secondary outcomes included all-cause readmissions, HF readmissions, emergency department (ED) visits, and healthcare resource utilization. Outcomes were obtained via linkages with administrative datasets. Among 4441 patients discharged alive, 50.7% were female. By 5 years, 63.6% and 65.5% of male and female patients, respectively, had died (p = 0.19); 85.4% and 84.4%, respectively, were readmitted (p = 0.35); and 72.2% and 70.9%, respectively, received ED care without hospitalization (p = 0.34). There were no sex differences in mean [SD] number of all-cause readmissions (males, 2.8 [7.8] and females, 3.0 [8.4], p = 0.54), HF readmissions (males, 0.9 [3.6] and females, 0.9 [4.5], p = 0.80), or ED visits (males, 1.8 [11.3] and females, 1.5 [6.0], p = 0.24) per person. There were no sex differences in mean [SD] annual direct healthcare cost per patient (males, $80 334 [116 762] versus females, $81 010 [112 625], p = 0.90), but males received more specialist, multidisciplinary HF clinic, haemodialysis, and day surgical care, and females received more home visits, continuing/convalescent care, and long-term care. Annualized clinical events were highest in first year following index discharge in both males and females. Among people discharged alive after hospitalization for HF, there were no sex differences in total and annual deaths, readmissions, and ED visits, or in total direct healthcare costs. Despite similar risk profiles, males received relatively more specialist care and day surgical procedures, and females received more supportive care. ClinicalTrials.gov NCT02112227.

Impact on healthcare costs of adding telemedicine to a multidisciplinary disease management program for heart failure: a sub-analysis of the iCOR trial

Abstract Background Impact of telemedicine on heart failure outcomes has shown conflicting results. Little is known about the effect of these programs on mid-term healthcare costs. Purpose To evaluate the cost-efficacy of a comprehensive telemonitoring program within the vulnerable post-discharge period after an acute heart failure admission. Methods The insuficiència cardiaca Optimizació Remota (iCOR) trial was a single-centre, randomized, open-label study designed to evaluate the efficacy of the addition of telemonitoring and teleintervention to a specialized multidisciplinary nurse-led heart failure (HF) program. Adult patients with a recent hospital admission for acute HF and an acceptable social support and cognitive ability were recruited. This sub-analysis evaluates the effect of telemedicine on mid-term healthcare costs, including clinical events, drugs and devices, technology purchase and maintenance, outpatient care, days of hospitalization, procedures and complementary tests. t-test via bootstrap estimation is used to compare differences between the telemedicine (TM) and the usual care (UC) groups. Results 81 patients were assigned to the TM group and 97 patients to the UC group. Mean age was 74 years, more than 50% had HF with preserved ejection fraction and 25% were frail. Baseline characteristics were well-balanced between groups. Among the TM subgroup, adherence was very high (< 1% of missed biometric daily transmissions). During 6 months of follow-up, mean total healthcare cost per patient was 7949 euros (€) in the UC cohort and 4383 € in the TM cohort (relative risk reduction [RRR] of 45%; between-group differences 3546 €, 95% confidence interval 627-6464 €, bootstrap achieved significance level 0.022). This result was consistent across several subgroups (age, sex, frailty, left ventricular ejection fraction, educational level) and mainly driven by a 63% RRR in costs of hospitalization (which accounted for two-thirds of the total costs) in the TM cohort. 20 patients required HF admissions in the TM group, compared to 51 patients in the TM group (p < 0.001). This was associated with a 59% RRR in the need for diagnostic procedures. Total number of days of hospitalization per patient decreased from 12.2 in the UC group to 4.2 days in the TM group (p = 0.003), impelled by a reduction in HF and cardiovascular days of hospital stay. On the contrary, ambulatory care costs increase two-fold in the TM group compared to UC group. Nevertheless, these costs only accounted for a 19% of the total costs. Cost of devices needed to implement TM supposed 698 € per patient. Use of TM was associated with a 355 € increase in the cost of ambulatory neurohormonal treatment for HF. Conclusions TM implementation during the vulnerable phase after an acute HF admission was associated to a 45% RR reduction in mean total healthcare cost per patient. This result was driven by an almost two-thirds decrease in costs of hospitalization.UC and TM total healthcare costs

Evaluating an integrated clinical pharmacy service model in an ambulatory cardiac clinic- a single centre study

Abstract Background Evidence suggests that multidisciplinary cardiology clinics improve patient outcomes. Currently, there is limited data on the type of pharmacist-led interventions occurring in cardiac ambulatory clinics in the Australian setting. Purpose The primary aim of this pilot audit is to examine the frequency and type of pharmacist-led interventions in the ambulatory clinics of this specialist hospital. The secondary aim is to assess factors associated with hospital readmissions within 30 days of Pharmacists' reviews. Methods A retrospective pilot audit was conducted for patients who attended an integrated multidisciplinary Heart Failure (HF) and Hypertension (HTN) clinic from April 2023 to February 2024. Patients’ demographics, Charlson comorbidity index (CCI), and the number and types of pharmacist interventions and readmission data 30 days post clinic review were recorded. Descriptive statistics were used to evaluate patient characteristics and logistic regression for hospital readmissions. Results A total of 398 patients were reviewed by pharmacists, with 300 (75%) from the HF clinics and 98 (25%) from the HTN clinics. Patients’ median age was 63± 14.8 years and median CCI was 4± 3.7. Pharmacists documented medication histories for all patients (100%) and provided 355 recommendations, of which 213 (60%) were actioned by the cardiologist. Pharmacists had a face-to-face consultation and provided education and counselling to 175 (44%) patients. The most common types of interventions were related to guideline-directed prescribing and deprescribing (68, 39%), followed by up-titration of current therapies (61, 35%). Pharmacists also provided education on medication adherence and lifestyle modifications (28, 16%) as well as optimizing medications related to other comorbidities (18, 10%). A total of 8 patients (2%) were re-admitted l within 30 days of clinic review from either heart failure exacerbation or hypertensive crisis. Patients who had a face-to-face consultation and education with a pharmacist were less likely to be readmitted within 30 days (P=0.048). However, none of the other predictors tested for readmission such as age (P= 0.572), gender (0.296), history of non-compliance (0.834), CCI (0.984) or a diagnosis of HF or HTN (0.473) were predictors for readmission within 30 days of clinic review. Conclusion Pharmacists play an integral role in the cardiac ambulatory setting by providing expert medication advice and patient education to optimize patients’ outcomes. This study demonstrates that the activities performed by pharmacists working in Australian cardiac clinics are consistent with other international ambulatory clinics. The study also identified opportunities to develop a similar service for other ambulatory clinics at this hospital such as lipid and atrial fibrillation clinics. Additionally, further research is required to assess long term benefit of pharmacist led interventions on cardiac patients.

Incidence of 1-year mortality, heart failure admissions and decompensation in patients with heart failure followed in HF units in Spain. Differences according to type of units

Abstract Introduction Heart failure is a serious health problem and continues to have a high mortality and incidence of decompensation, despite advances in its management. The introduction of specific multidisciplinary HF units has improved the management of patients with this disease, thanks to better organization and management of available diagnostic and therapeutic resources. The HF Association of the ESC and the Spanish Society of Cardiology have defined 3 types of HF units (community, specialized, and advanced) according to their structure, complexity, and portfolio of services. Purpose To analyze in a contemporary registry of patients with HF followed up in HF units in Spain whether the results in terms of mortality and HF decompensations during follow-up are similar or different between the 3 types of units. Methods We analyzed data from the registry of the SEC-Excelente-IC quality accreditation program of the Spanish Society of Cardiology, with 1,716 patients with HF included between 2019 and 2021 by 45 SEC-accredited HF units. Patients were included consecutively in two 1-month cutoffs (March and October) in that period. Units were defined as community, specialized, and advanced according to ESC HFA and SEC criteria. We compared the incidence of death, HF admissions and total decompensations at 1-year follow-up between community and specialized/advanced units. Results Of the 1716 patients, 55.5% were treated in community units, 65.9% in advanced units, and 20.9% in advanced HF units. Figure 1 shows the main characteristics and treatment used in the 3 types of units. The community units treated older patients and more HFpEF, and the use of NRA and AID was lower, with no differences in the remaining characteristics, comorbidities, or treatments (Figure 1). Figure 2 shows the incidence of events at 1 year. Total mortality was 27.5% in community and 15.5% in specialized/advanced (p<0.001). HF admissions (39.7 vs 29.2%; p=0.019), HF decompensations without admission (16.4 vs 11.3%; p=0.074), total decompensations (56.1 vs 40.5%; p=0.003), and combined HF death/admissions (45.2 vs 31.4%; p=0.005) were statistically higher in community units. Control in specialized/advanced units was an independent protector factor for all events (mortality: HR 0.59, 0.43-0.82; p=0.002; HF admissions: HR 0.61, 0.42-0.90; p=0.012; total HF decompensations: HR 0.58, 0.42-0.81; p=0.001). Conclusions One-year prognosis of HF patients continues to be poor, with high rates of mortality and decompensations. Patients attended in community HF units was significantly worse in our country during the study period. Although this may be due in part to the small differences between the characteristics of the patients followed in the different types of units, it seems necessary to improve the network organization of HF care with the aim of achieving greater equity in the treatment of HF in Spain.

Diagnostic and therapeutic practice for HFpEF across continents and regions: An international survey.

This study aims to evaluate the worldwide variations in the diagnosis and treatment of heart failure with preserved ejection fraction (HFpEF), using an HF survey distributed internationally to physicians, including both cardiologists and non-cardiologists. A group of HF specialists designed an independent, academic web-based survey focusing on HFpEF care and diagnosis, which was distributed via scientific societies and various social networks between 1 May 2023 and 1 July 2023. The survey included 1459 physicians (1242 cardiologists and 217 non-cardiologists) from 91 countries, with a mean age of 42 (34-49) years and 61% male. Most physicians (89.2%) defined HFpEF as left ventricular ejection fraction ≥50%. Significant regional variations were observed in HFpEF management (P<0.001 for all comparisons unless stated otherwise). Cardiologists managed 63.1% of HFpEF patients overall, with significant variability across regions (P < 0.001). The estimated HFpEF prevalence was highest in Eastern Asia and Western Europe and lowest in Africa and South America. Diagnostic practices varied: natriuretic peptide use ranged from 70%-74% in Africa to 95%-97% in Southern/Western Europe. Echocardiographic parameters showed regional differences, with diastolic stress testing used most in South-Eastern Asia (47% vs. 13-36% elsewhere). HFpEF scoring systems were most common in South-Eastern Asia (78%) and least in Africa (30.1%). Coronary artery disease screening approaches differed, with Eastern Asian physicians more likely to always perform routine angiograms (52%) compared with Northern Europeans (12%). Treatment preferences also varied regionally. Sodium glucose co-transporter-2 inhibitors (SGLT2i) was the preferred first-line treatment (45%-70% across regions), followed by diuretics. In an ideal setting, 52% would primarily use SGLT2i, 33% loop diuretics, and 22% beta-blockers. Drug availability differed significantly: SGLT2i was most available (88% overall), while ARNI was least available (61%). South America and Middle Eastern/Northern Africa reported lower availability of guideline-directed therapies. Multidisciplinary HF programmes were most common in Asia (70%) and least in Africa (24%). The perceived benefit of atrial flow regulator devices also showed significant regional differences. There are considerable global variations in the diagnosis and management of HFpEF. Most physicians favour SGLT2i despite regional disparities in health care resources and guideline adherence. Harmonized practices and improved access to comprehensive care can enhance outcomes of HFpEF patients worldwide.

Outcomes of a New Multi-Disciplinary Outpatient Heart Failure Service in a Tertiary Hospital

Outcomes of a New Multi-Disciplinary Outpatient Heart Failure Service in a Tertiary Hospital

Achieving consensus on the key elements of a nurse-led multidisciplinary chronic heart failure service in Thailand: An e-Delphi study.

To describe the outcomes of an e(electronic)-Delphi survey used to achieve consensus on the essential elements that should be included in a multidisciplinary, nurse-led service for patients with chronic heart failure (CHF). The study design was based on a three-round e-Delphi survey. A series of three survey rounds were used to gather expert opinions and achieve consensus on the key elements that should be included in a CHF disease management program from a sample of healthcare professionals and organizational leaders with expertise in existing CHF services. Consensus for each item was defined as at least 90% agreement. There were 20 participants (18 healthcare professionals and 2 organizational leaders) in round-1, 22 (20 healthcare professionals and 2 organizational leaders) in round-2, and 17 (15 healthcare professionals and 2 organizational leaders) in round-3. Fifteen participants attended a final online meeting (13 healthcare professionals and 2 organizational leaders). Consensus was obtained on five essential components: (i) consumer education, (ii) treatment optimization using a multidisciplinary approach, (iii) discharge planning, (iv) provision of supportive community care and (v) mechanisms to respond to early symptoms of decompensated CHF. Participants focused on mechanisms to improve treatment effectiveness, patient and family knowledge, communication between healthcare providers and supportive care in the community. The proposed model of care may be useful to other health service providers who are designing or adapting CHF models of care for the South-East Asian environment. This research provides a solid basis for using a Delphi method to resolve the challenges and issues of transferring global model-based recommendations in CHF knowledge. The Delphi method proved successful as an important step in developing a culturally acceptable model of chronic care that meets the goals of local healthcare providers.

Early experience with baroreflex activation therapy from a vascular surgery perspective

Baroreflex activation therapy (BAT) is an emerging device-based treatment for patients with heart failure with a reduced ejection fraction refractory to maximally tolerated goal-directed medical therapy. Currently, there is sparse literature on the critical role that vascular surgeons serve in the delivery of this novel therapy. This single-institution series describes the creation of a BAT program and elaborates on the function of vascular surgeons in the multidisciplinary heart failure team. The preoperative evaluation, perioperative care, and postoperative course of patients receiving BAT from March 2022 to August 2023 were retrospectively analyzed. Eleven patients were evaluated by a dedicated heart failure cardiologist for medical eligibility and assessed by a vascular surgeon for technical feasibility. Of the 11 patients, 7 were men (63.6%). The median age was 60.5 years (range, 44-73 years). No patient (0.00%) had existing carotid artery disease, and one patient (9.1%) had undergone previous neck radiation therapy. All 11 patients (100%) had an existing cardiac implantable electronic device, and BAT implantation was performed on the same side as the cardiac implantable electronic device in two patients (18.1%). Four patients (36.4%) required preoperative hospital admission for medical optimization before surgery. The median length of surgery was 82 minutes (range, 58-113 minutes), and the median length of stay in the hospital after surgery was 1 day (range, 0-6 days). No major adverse neurologic or cardiovascular events, cranial nerve injuries, device complications requiring reintervention, or heart failure-related mortality at 6 months occurred. Three patients (27.3%) experienced extraneous stimulations, which affected BAT tolerability. Within 6 months after BAT implantation, no significant improvements were observed for several heart failure disease burden markers compared with 6 months before BAT implantation. Our early results demonstrate that BAT implantation is a safe procedure with rare complications. Vascular surgeons play an important role in the multidisciplinary delivery of this novel device-based therapy. More data are needed to understand whether BAT is beneficial in the treatment of heart failure with a reduced ejection fraction refractory to maximally tolerated goal-directed medical therapy.

Impact of Multidisciplinary Heart Failure Clinic on Guideline-Directed Medical Therapy and Clinical Outcomes.

Heart failure (HF) is associated with recurrent hospital admissions and high mortality. Guideline-directed medical therapy has been shown to improve prognosis for patients who have HF with reduced ejection fraction (HFrEF). Despite the proven benefits of guideline-directed medical therapy, its utilization is less than optimal among patients with HF in Malaysia. To determine the impact of a multidisciplinary team HF (MDT-HF) clinic on the use of guideline-directed medical therapy and patients' clinical outcomes at 1 year. This retrospective study was conducted in a single cardiac centre in Malaysia. Patients with HFrEF who were enrolled in the MDT-HF clinic between November 2017 and June 2020 were compared with a matched control group who received the standard of care. Data were retrieved from the hospital electronic system and were analyzed using statistical software. A total of 54 patients were included in each group. Patients enrolled in the MDT-HF clinic had higher usage of renin-angiotensin system blockers (54 [100%] vs 47 [87%], p < 0.001) and higher attainment of the target dose for these agents (35 [65%] vs 5 [9%], p < 0.001). At 1 year, the mean left ventricular ejection fraction (LVEF) was significantly greater in the MDT-HF group (35.7% [standard deviation 12.3%] vs 26.2% [standard deviation 8.7%], p < 0.001), and care in the MDT-HF clinic was significantly associated with better functional class, with a lower proportion of patients categorized as having New York Heart Association class III HF at 1 year (1 [2%] vs 14 [26%], p = 0.001). Patients in the MDT-HF group also had a significantly lower rate of readmission for HF (4 [7%] vs 32 [59%], p < 0.001). Patients who received care in the MDT-HF clinic had better use of guideline-directed medical therapy, greater improvement in LVEF, and a lower rate of readmission for HF at 1 year relative to patients who received the standard of care.

The Impact of Specialised Heart Failure Outpatient Care on the Long-Term Application of Guideline-Directed Medical Therapy and on Prognosis in Heart Failure with Reduced Ejection Fraction.

(1) Background: Besides the use of guideline-directed medical therapy (GDMT), multidisciplinary heart failure (HF) outpatient care (HFOC) is of strategic importance in HFrEF. (2) Methods: Data from 257 hospitalised HFrEF patients between 2019 and 2021 were retrospectively analysed. Application and target doses of GDMT were compared between HFOC and non-HFOC patients at discharge and at 1 year. 1-year all-cause mortality (ACM) and rehospitalisation (ACH) rates were compared using the Cox proportional hazard model. The effect of HFOC on GDMT and on prognosis after propensity score matching (PSM) of 168 patients and the independent predictors of 1-year ACM and ACH were also evaluated. (3) Results: At 1 year, the application of RASi, MRA and triple therapy (TT: RASi + βB + MRA) was higher (p < 0.05) in the HFOC group, as was the proportion of target doses of ARNI, βB, MRA and TT. After PSM, the composite of 1-year ACM or ACH was more favourable with HFOC (propensity-adjusted HR = 0.625, 95% CI = 0.401-0.974, p = 0.038). Independent predictors of 1-year ACM were age, systolic blood pressure, application of TT and HFOC, while 1-year ACH was influenced by the application of TT. (4) Conclusions: HFOC may positively impact GDMT use and prognosis in HFrEF even within the first year of its initiation.

Exploring heart failure nurse practitioner outcome measures: a scoping review.

Clinical guidelines recommend people with heart failure are managed within a multidisciplinary team to receive optimal evidence-based management of the syndrome. There is increasing evidence that Nurse Practitioners (NP) in heart failure demonstrate positive patient outcomes. However, their roles as key stakeholders in a multidisciplinary heart failure team are not clearly defined. The aim of the review was to explore the literature related to NP-sensitive outcomes in heart failure. A scoping review was conducted according to accepted guidelines using the Joanna Briggs Institute framework for conducting a scoping review, to identify the literature that related to NP-sensitive outcomes in heart failure management. Sixteen texts were selected for data extraction and analysis. The most common outcome measures reported were readmission rates, self-care measurement scales, functional status scores, quality of life measurements, and medication optimization outcomes. No two studies collected or reported on the same outcome measurements. This review highlights that the reporting of heart failure (HF) NP outcome indicators was inconsistent and disparate across the literature. The outcome measures reported were not exclusive to NP interventions. Nurse Practitioner roles are not clearly defined, and resulting outcomes from care are difficult to characterize. Standardized NP-specific outcome measures would serve to highlight the effectiveness of the role in a multidisciplinary HF team.

One-year Outcomes Of Patients With HFrEF Followed At A Multidisciplinary Heart Failure Clinic In The Middle East: HFimpEF Vs. Persistent HFrEF

One-year Outcomes Of Patients With HFrEF Followed At A Multidisciplinary Heart Failure Clinic In The Middle East: HFimpEF Vs. Persistent HFrEF

Shaping the future of Heart Failure Care

Heart failure (HF) hospitalisations are commonly associated with increased mortality and morbidity. The multi-disciplinary HF workgroup was formed in 2016 comprising Cardiologists, HF Case Managers, Advanced Practice Nurses, Cardiac Pharmacists, Allied Health Professionals and Operations personnel. The group focuses on delivering an end-to-end HF care, that aims to improve clinical and functional outcomes, while keeping cost affordable to patients. Our early initiatives were targeted at the inpatient phase; with current shift towards patient-centred and value-driven care, it presents an opportunity to delve deeper into patients’ journey.&#x0D; Our HF workgroup aims to implement a series of initiatives targeting pre-admission (HF - Extended Diagnostic and Treatment Unit (EDTU)) and post-discharge phases (HF Shared Care (HFSC) and Medical Home (MH)) of the patient’s journey, supporting their health needs in the community, thus reducing avoidable hospital readmissions.&#x0D; Foremost, the team mapped out the patients’ journey and adopted a multi-pronged approach to i) manage mild HF patients presented to Emergency Department (ED) under HF-EDTU protocol and support ii) stable HF patients with co-morbidities (HFSC programme) and mild-to-moderately decompensated HF patients (MH programme) in the community. &#x0D; Under HF-EDTU protocol (commenced Mar’ 22), brainstorming sessions were conducted with ED to determine the inclusion criteria to ensure safe discharge from ED. For HFSC programme (commenced Jul’ 22), we engaged Shared Care Partnership Office (SCPO) to partner General Practitioners (GPs) to co-manage stable HF patients with co-morbidities in the community. GP focus group discussions were held to gather inputs for effective implementation of HFSC programme. We also worked with Population Health and Community Transformation (PHCT) team to identify patients with haemodynamically stable medical conditions for MH programme (commenced Jun’ 22) to reduce unnecessary hospitalisation. Regular meetings were conducted to monitor and evaluate the progress of our initiatives.&#x0D; Collectively, these initiatives contributed to a decrease in 30D readmission rate from 8.4% to 6.8% (≈19% relative reduction) and a decrease in total bill size from $4,847 to $4,802, when comparing across the pre (Apr 2021 – Mar 2022) and post-implementation of initiatives (Apr 2022 onwards).&#x0D; To date, of the 11 HF-EDTU patients, 5 were discharged from EDTU, avoiding inpatient admission. This resulted in estimated cost savings of $7,595. Separately, 5 patients were enrolled into HFSC programme.&#x0D; &#x0D; By adopting a strong value-driven methodology, we were able to assess and identify gaps in existing processes to create more value for our patients. Despite the short period of implementation, the drop in 30D readmission rate is testament to better and safer quality of care received by our patients. By working closely with private primary care providers, patients are able to embark on a lifelong relationship with their GPs to manage different aspects of their health (including preventive care). This is crucial as we tackle the wave of an ageing population and the rising impact of multiple chronic diseases.&#x0D; With the current promising results, continuous Plan-Do-Study-Act cycles will refine and improve the uptake of our initiatives. Lastly, measurement of patient experience outcomes are underway to truly understand what matters to patients in their care journey.

Eligibility and prescribing rates of SGLT2 inhibitors for ambulatory patients with heart failure and reduced ejection fraction in a multidisciplinary heart failure management programme

Abstract Introduction Sodium-glucose cotransporter 2 (SGLT2) inhibitors dapagliflozin or empagliflozin are recommended, in addition to optimal medical therapy (OMT), for patients with heart failure with reduced ejection fraction (HFrEF) regardless of diabetes status.(1) Both have been licensed for use in the UK NHS by NICE,(2,3) but the proportion of 'real world' heart failure (HF) patients for whom these guidelines are applicable is unknown. For those eligible, multidisciplinary HF management programmes (HF-MPs), may enable more rapid translation of guidelines into practice.(1) Purpose We aimed to identify the patients eligible to start, and those prescribed, SGLT2 inhibitors amongst patients attending a HF-MP at a tertiary centre in the UK. We also assessed for variation by age and sex. Methods In this single-centre retrospective study we selected consecutive patients who attended a heart failure clinic appointment between 01 November 2020 - 01 March 2021. We extracted information pertaining to baseline demographics, investigations, and therapies relevant to eligibility for SGLT2 inhibitors, and prescription of SGLT2 inhibitors at baseline and 2-year follow-up. Differences in SGLT2 inhibitor prescription by age and sex were analysed using the χ2 test. All tests were two-sided, and statistical significance was considered as p value &amp;lt;0.05. Results Over this period, 296 stable chronic HF patients attended the centre. The majority of patients had HFrEF (53%),4 and there was a broad age distribution including the very elderly (28% &amp;gt; 80 years) (Table 1). Patients with HFrEF were well optimised [beta blocker (86%), angiotensin-converting enzyme/ angiotensin receptor blocker (61%), sacubitril- valsartan (23%), mineralocorticoid receptor antagonist (50%)] (Table 1). Of the whole cohort, 107 (36%) patients met eligibility for SGLT2 inhibitor prescription, with 24 (8%) already receiving a SGLT2 inhibitor at the point of guideline implementation, of whom 15 (5%) had diabetes mellitus (Figure 1). At 2-year follow-up 64 eligible individuals (22%) were prescribed a SGLT2 inhibitor, meaning that prescription amongst eligible individuals had increased from 22% to 60%, with greater improvement in younger individuals (Figure 1). Age-stratified analysis revealed that at least 30% of clinic attendees in each decile were eligible for SGLT2 inhibitors, and almost half of sexagenarian attendees (47%). Though there was not a disparity in prescription of SGLT2 inhibitors for women compared to men (51% vs 64% p=0.22), those aged ≥80 years less frequently received SGLT2 inhibitors compared with younger individuals (33% vs 69%, p&amp;lt;0.001). Conclusions Among stable HF patients in a ‘real world’ setting, a significant proportion are eligible for SGLT2 inhibitors. Patients attending a HF-MP have benefitted from early implementation of novel guidelines, though there are age-determined gaps in SGLT2 inhibitor prescription that represent an actionable target.Table 1Figure 1

The power of optimal medical therapy in heart failure with secondary mitral regurgitation

Abstract Background Guideline-directed medical therapy (GDMT) for the management of heart failure (HF) may impact on the frequency of severe secondary mitral regurgitation (SMR). Objective To evaluate the impact of optimization of GDMT on the grade of SMR in a cohort of HF patients managed in a multidisciplinary HF clinic and to assess predictors and prognosis of deterioration of SMR. Methods In a prospective, consecutive, observational registry of HF patients, a 2-dimensional transthoracic echocardiography was performed at baseline and at 1 year of follow-up. Patients treated with surgical or interventional mitral valve repair were excluded. The primary endpoint was all-cause death. Results Of a total of 2.980 HF patients, 1814 patients had 2 echocardiograms performed 1 year apart. At baseline, 99 patients had a severe SMR (5.5%), 389 (21.4%) moderate and the remainder had mild, trace or none SMR. After 1-year, 80.8% of those with baseline severe SMR presented a regression to non-severe SMR, 66.6% of those with moderate SMR regressed to mild SMR and 1.1% of those with non-severe SMR at baseline worsened to severe SMR. Older age (OR 1.42 per every decade; 95% CI 1.19-1.69, p&amp;lt;0.001), ischaemic aetiology of HF (OR 1.64; 95% CI 1.11-2.42, p&amp;lt;0.001) and baseline NTproBNP (OR 1.19; 95% CI 1.08-1.32, p&amp;lt;0.001) were independently associated with worsening of SMR at 1 year of follow-up. Patients with baseline severe SMR that improved at 1 year had a similar risk of the primary endpoint to those with non-severe SMR at both time points (HR 0.93; 95% CI 0.62-1.42; p=0.75), even after adjusting for age, sex and LVEF (HR 0.99; 95% CI 0.65-1.52; p= 0.98). On the contrary, patients with non-severe SMR that worsen showed the worst prognosis (Figure 1). Conclusions Most of the patients with HF and severe SMR show a regression of SMR within 1 year of GDMT. Patients with baseline severe SMR that improved at 1 year have a similar prognosis than those with non-severe SMR at both time points. Older age, ischaemic aetiology and higher levels of NTproBNP were associated with deterioration of SMR.Table 1.Population characteristicsFigure 1.Survival curves

Abstract 14872: A Nationwide Telehealth Heart Failure Program: Can Remote Patient Monitoring and Guideline Directed Treatment Protocols Benefit HFpEF Management?

Introduction: Heart failure (HF) patients experience unnecessary morbidity and mortality due to inadequate use and dose of GDMT. While RPM has proven to help HFrEF patients achieve higher rates of GDMT, its value in optimizing comorbidities and GDMT in HFpEF patients is less clear. Hypothesis: A team of multi-disciplinary HF clinicians can leverage RPM and guideline directed treatment protocols to bridge the gaps in HFpEF management. Methods: Cadence enrolled Medicare patients with HFpEF across 11 states into a virtual HF program from December 2021 to April 2023. Eligible patients had either an ICD-10 code for diastolic HF, diastolic dysfunction on TTE, or an EF&gt;50% and a prior HFH or active treatment for HF by their clinician. Patients were given a cellular enabled BP cuff and weight scale to measure vitals. Coupling a technology enabled vitals and symptoms tracker with a guideline directed clinical protocol algorithm, symptom, vital and medication optimization was achieved. Results: Two-hundred fifteen patients (mean (SD) values: age 76 (9); white 64%, women 49%; BP 141/79 (9/6) mmHg; EF 60% (0.1)) were followed for a mean of 223 (82) days. Comorbidities, including DM (41%), AF (53%) and HTN (92%), were highly prevalent. There was a statistically significant reduction in BP and weight, but not heart rate (BP: -11/6 mmHg, Wt -4 lbs; p&lt;0.001). Patient engagement information, including number of vitals recorded, clinical visits and phone calls completed, and high acuity clinical alerts resolved, is depicted in Figure 1A. There was a 286% and 71% increase in percentage of patients on a SGLT2i and MRA, respectively, at follow-up compared to baseline (SGLT2i: 15 (7%) vs. 44 (20%); p&lt;0.001, MRA: 30 (14%) vs. 50 (24%); p&lt;0.05). Additional changes in use and dose of GDMT are shown in Figure 1B. Conclusion: A telehealth HF program that utilizes RPM and technology enabled treatment protocols can meaningfully improve HF-specific vitals and rates of GDMT in patients with HFpEF.

Abstract 12961: Heart Failure Redesign Across a Newly Integrated Health System

Introduction: Heart Failure (HF) challenges are magnified when healthcare mergers and expansions occur requiring significant integration of operational and clinical effort. With enterprise support, we brought HF teams together from a newly merged system to 'redesign' HF care aiming to provide high level, consistent, evidence-based, patient-centered care in a novel, adaptive model where such roadmaps do not exist. Hypothesis: Integrated care across a large network can be patient centered, of high value, with a proper framework. Methods: Representatives from 3 distinct, newly aligned regions of Intermountain Health completed a care redesign program aimed to integrate HF services. Current processes, tools, education were evaluated then mapped to identify barriers and most impactful areas to guide redesign. Results: Over 6 months, 45 multidisciplinary HF specialists met weekly. Current state was mapped for 9 markets across 3 regions reaching &gt;38,089 patients. Baseline data revealed areas for improvement: readmissions, mortality, advanced care planning, transitions in care. 141 barriers were identified, 39 of high impact, 15 are the primary focus; includes increasing access to stage-based care, implementing a guideline-directed referral pathway and providing market-specific resources. 4 teams built an operating system to support a new HF standard (image). Elements culminated in a consistent care path across the HF Stages for the newly formed enterprise. Implementation is underway; outcomes will be forthcoming. Conclusion: Building HF care across a large healthcare organization takes both clinical and operational leadership through shared learning. With a vision and framework this redesigned system aims to increase ease and access while providing high quality, patient-centered, consistent care regardless of location. Attention to high areas of opportunity requires operational prioritization, subject matter expertise, and resource support.

The role of nurses in the multidisciplinary heart failure team: we are one but we are not the same.

Nurses play a multifaceted and pivotal role in managing patients with heart failure (HF), their contributions encompass assessment, education, symptom management, and psycho-social support. Teamwork with cardiologists and other healthcare professionals, combined with the integration of e-Health and telemedicine technologies, ensures a comprehensive and coordinated approach to HF management. Every team that treats and monitors patients with HF should invest in training highly specialized nurses since their contribution significantly improve outcomes and patient well-being. The present editorial summarizes the contribution of the nurse's role within the multidisciplinary team of care and management of heart failure patients.

Impact of a heart failure multidisciplinary clinic on the reduction of healthcare-related events and costs: the GEstIC study.

Heart failure (HF) is the leading cause of hospitalization in the elderly in developed countries and significantly impacts public health expenditures. Patients with HF usually have associated comorbidities that require multidisciplinary management. This study aims to demonstrate the benefits of a multidisciplinary clinic in reducing all-cause hospitalizations and HF events (HF hospitalizations and urgent HF visits) in a real-world setting. Finally, the study evaluates the associated costs of HF events. This observational study included patients admitted to GEstIC, a multidisciplinary Portuguese HF clinic, from January 2013 to February 2019, who had one-year follow-up. Hospitalizations and HF events, total days spent in the hospital during HF hospitalizations, and HF events-related costs, in the year before and the year after GEstIC admission, were compared. Of the 487 patients admitted to the GEstIC, 287 were eligible for the study sample. After one year of HF patients' multidisciplinary management at GEstIC, there was a 53.7% reduction in all-cause hospitalizations (462 vs. 214), a 71.7% reduction in HF hospitalizations (392 vs. 111), and a 39.1% reduction in urgent HF visits (87 vs. 53). As a result, there was a significant decrease of 12.6 days in the length of hospital stay due to HF per patient (15.6 vs. 3.0, p < 0.001). This translated into the release of 9.9 hospital beds in the year following admission to GEstIC. The average total savings associated with the reduction of HF events was €5,439.77 per patient (6,774.15 vs. 1,334.38, p < 0.001), representing a total cost reduction of €1,561,213. Furthermore, the significant reduction in the number of all events was independent of the patient's left ventricular ejection fraction (LVEF). Significant reductions in all-cause and HF hospitalizations and urgent HF visits were observed with the implementation of this multidisciplinary clinic for HF patients' management. This was particularly important for patients with LVEF >40%. Before GEstIC, there was no medical intervention to improve the prognosis of these patients. The reduction of over one million euros in health-related costs after only one year of person-centered multidisciplinary management highlights the need to replicate this approach in other national healthcare institutions.

The prevalence of cardiorenal anemia syndrome among patients with heart failure and its association with all-cause hospitalizations: a retrospective single-center study from the Middle East.

Little is known about the burden of cardiorenal syndrome (CRS) and cardiorenal anemia syndrome (CRAS) in the Middle East Region. Furthermore, whether the occurrence rates of CRAS differ across heart failure (HF) phenotypes is not widely investigated. We aimed to examine the prevalence of CRS and CRAS in patients with HF, compare characteristics of patients with CRAS-HFrEF vs. CRAS-HFpEF, and investigate anemia association with 1-year all-cause hospitalizations. HF patients who visited a multidisciplinary HF clinic at a single center between 10-2015 and 06-2022 (n = 968) were retrospectively included. Differences in rates of CRAS prevalence, and patients' characteristics of those with CRAS-HFrEF vs. CRAS-HFpEF were determined using appropriate testing methods. Generalized estimating equation (GEE) models were used to determine if anemia was associated with higher rates of hospitalization. CRS was prevalent in 34.4% of subjects, while 25.3% had CRAS. CRAS prevalence rates among patients with HFpEF vs. HFrEF were comparable (27.2% vs. 24.2%, p = 0.3). Compared to patients with HFrEF-CRAS, those with HFpEF-CRAS were more likely females (p < 0.001), had a higher burden of hypertension (p = 0.01), and lower hemoglobin (p = 0.02). In an adjusted GEE model, anemia was associated with an average increase of 1.8 admissions in CRS patients (p = 0.015). In patients with HF, 1 in 3 patients presented with CRS, and 1 in 4 patients had CRAS. The prevalence of CRAS was comparable among those HFpEF and HFrEF. Anemia was associated with an increased rate of 1-year all-cause hospitalization in CRS patients.