Specialist intervention is associated with improved patient outcomes in patients with decompensated heart failure: evaluation of the impact of a multidisciplinary inpatient heart failure team

Jayne Masters, Geraint Morton, Isabel Anton, Jane Szymanski, Elizabeth Greenwood, Joanna Grogono, Andrew S Flett, John G F Cleland, Peter J Cowburn, Jayne Masters, Geraint Morton, Isabel Anton, Jane Szymanski, Elizabeth Greenwood, Joanna Grogono, Andrew S Flett, John G F Cleland, Peter J Cowburn

Abstract

Objective: The study aimed to evaluate the impact of a multidisciplinary inpatient heart failure team (HFT) on treatment, hospital readmissions and mortality of patients with decompensated heart failure (HF).

Methods: A retrospective service evaluation was undertaken in a UK tertiary centre university hospital comparing 196 patients admitted with HF in the 6 months prior to the introduction of the HFT (pre-HFT) with all 211 patients seen by the HFT (post-HFT) during its first operational year.

Results: There were no significant differences in patient baseline characteristics between the groups. Inpatient mortality (22% pre-HFT vs 6% post-HFT; p<0.0001) and 1-year mortality (43% pre-HFT vs 27% post-HFT; p=0.001) were significantly lower in the post-HFT cohort. Post-HFT patients were significantly more likely to be discharged on loop diuretics (84% vs 98%; p=<0.0001), ACE inhibitors (65% vs 76%; p=0.02), ACE inhibitors and/or angiotensin receptor blockers (83% vs 91%; p=0.02), and mineralocorticoid receptor antagonists (44% vs 68%; p<0.0001) pre-HFT versus post-HFT, respectively. There was no difference in discharge prescription rates of beta-blockers (59% pre-HFT vs 63% post-HFT; p=0.45). The mean length of stay (17±19 days pre-HFT vs 19±18 days post-HFT; p=0.06), 1-year all-cause readmission rates (46% pre-HFT vs 47% post-HFT; p=0.82) and HF readmission rates (28% pre-HFT vs 20% post-HFT; p=0.09) were not different between the groups.

Conclusions: The introduction of a specialist inpatient HFT was associated with improved patient outcome. Inpatient and 1-year mortality were significantly reduced. Improved use of evidence-based drug therapies, more intensive diuretic use and multidisciplinary care may contribute to these differences in outcome.

Keywords: Heart failure; Multidisciplinary Team.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Kaplan-Meier curve showing survival after admission to hospital in the pre-HFT and post-HFT cohorts. Survival was significantly higher in the post-HFT cohort. HFT, heart failure team.
Figure 2
Figure 2
Mortality, 1-year all-cause and HF readmission and specialist follow-up rates in the pre-HFT and post-HFT cohorts. *Denotes statistically significant difference between pre-HFT and post-HFT. HFT, heart failure team.

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