Impact of a Multidisciplinary Heart Failure Inpatient Service on 30-day Readmission at a Tertiary Care Center in a Developing Country

Abstract

Background: Patients admitted for Heart Failure (HF) are optimally managed through a dedicated multidisciplinary team. Contributions of such team result in better management during admission, intensive patient education, and closer follow-up upon discharge. The 2013 ACC/AHA guidelines recommend such disease management programs and a follow-up visit within 7 to 14 days after discharge. At our institution, a specialized multidisciplinary inpatient HF and transplant service was initiated on January 1, 2017. Methods: A retrospective chart review was conducted to identify patients admitted with a diagnosis of HF from April 1, 2015 to April 1, 2017. Patients admitted prior to starting the service (group 1) were compared to those admitted after the service (group 2). The two groups were compared for changes in renal function and weight between admission and discharge as well as the need for ICU admission, inotrope use, evidence-based discharge medications, length of stay, days to follow-up appointment, 30-day readmission and mortality. Chi-square and t-test comparisons were performed to compare the two groups. Results: A total of 100 (58% with HFrEF) and 60 (65% with HFrEF) patients were identified in group 1 and group 2 respectively. The average length of stay was significantly shorter in the time period after starting the HF service (13.6 ± 21.3 vs 6.8 ± 5.9 days, P < .05); less patients required ICU transfer (29% vs 15%, P < .05) and less patients were readmitted within 30 days following discharge (26% vs 7.1%, P < .05). Additionally, more patients discharged by the HF service were seen within 14 days of discharge (40.2% vs 77.1%, P < .001) with an average follow up of 25.9 ± 36.8 vs 9.9 ± 5.5 days, P < .001. Changes in weight and renal function were not significantly different between the two groups, and so was the use of evidence based medications for HFrEF upon discharge with a trend towards more beta blocker use in group 2. Conclusions: For patients admitted with decompensated HF, a dedicated HF inpatient service is effective in reducing length of stay, ensuring timely follow-up after discharge, and reducing readmissions.