United we stand, divided we conquer: pilot study of multidisciplinary General Medicine Heart Failure Care Program

Heart failure care and education require a multifaceted approach to ensure appropriate transition from inpatient to outpatient care.

To explore the feasibility of a multidisciplinary heart failure care model, General Medicine Heart Failure Care Program (GM-HFCP), within a General Medical Unit (GMU).

Prospective non-randomised before-and-after observational quality improvement intervention over a 6-month period was conducted. All consecutive patients admitted to GMU at Alfred Hospital, Melbourne with a diagnosis of acute decompensated heart failure were included. Main outcome measures included changes in rates of pharmacologic prescription, non-pharmacologic ward-based management, patient education and action plan provision after intervention.

In total, 108 patients were included (median age 84 (inter-quartile range 80-89) years, 47(44%) females). Significant improvements were noted in non-pharmacologic management for patient education regarding fluid restriction (12-30%, P = 0.04), weight monitoring (10-28%, P = 0.03), heart failure action plan on discharge (4-28%, P = 0.002) and salt restriction (6-32%, P = 0.002). The rates of prescription of heart failure medications remained similar between the pre- and post-implementation periods, particularly in patients with reduced ejection fraction by 'appropriateness of prescription' criteria. There were no differences in inpatient mortality or 30-day readmission rates in both groups.

This prospective observational study demonstrated that it is possible to share the roles of a heart failure nurse amongst members of the multidisciplinary team, with similar rates of delivery of pharmacologic and non-pharmacologic management aspects. However, further innovative improvements are needed to address certain aspects of heart failure care.