Impacts of integrated multidisciplinary care in heart failure clinic among tertiary care level hospitals: A retrospective cohort study

Abstract

Background: Heart failure (HF) causes a high morbidity and mortality rate and is also one of the most common causes of unscheduled hospital admissions.

Objective: To determine clinical outcomes of high-risk heart failure patients treated by multidisciplinary care at Chonburi HF clinic.

Methods: A retrospective cohort study was conducted in the HF clinic at Chonburi Hospital. Data included rehospitalization, quality of life score, knowledge score, 6 minute walk test, left ventricular ejection fraction (LVEF), percent of achieving a standard dose of HF medications, and cost of HF hospitalization at baseline and 6^thto 12^th month follow-up.

Results: Eighty-two patients were treated and followed up at the HF clinic from 1^st February 2017 to 19^th February 2020. Mean age was 56.7 ± 14.5 years, and 43 patients (51.2%) were male. Sixty-seven patients (81.7%) were previously admitted from acute decompensated HF. The baseline means LVEF (%) was 33.2 ± 12.8. After entering the HF clinic, the total HF hospitalization was reduced from 1.4 times/person-year to 0.2 times/person-year (7 time reduction). The mean LVEF (%) was increased to 45.0 ± 15.4 and 49.9 ± 13.1 at the 6^th and 12^th months, respectively. The 6 minute walk test (meter) had improved from 369.0 ± 132.2 (in the 6^th month) to 399.0 ± 153.3 (in the 12^th month). The cumulative hospitalization cost before the HF clinic of 1,831,660.00 Baht was reduced to 105,128.75 Baht (17-time reduction).

Conclusions: A multidisciplinary approach to managing high-risk HF patients can substantially reduce rehospitalization rates and costs. These programs have improved LVEF, symptoms, quality of life, and HF knowledge and helped achieve the treatment to target dose of HF standard medications.

Keywords: , , , .