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

Tan SS 1 , Hisham SA 2 , Bin Abdul Malek AM 3 , Lik CP 4 , Lau GSK 4 , Bin Abdul Ghapar AK 5

Affiliations 

  • 1 , BScPhm, RPh, MClinPharm, is a clinical pharmacist with Sultan Idris Shah Serdang Hospital, Selangor, Malaysia
  • 2 , PhD, MedSc, is with the Faculty of Pharmacy, University of Cyberjaya, Selangor, Malaysia
  • 3 , MBBS, MMed (Internal Medicine), is a cardiologist with Sultan Idris Shah Serdang Hospital, Selangor, Malaysia
  • 4 , MBBS, MRCP, is a cardiologist with Sultan Idris Shah Serdang Hospital, Selangor, Malaysia
  • 5 , MD, MMed (Internal Medicine), is Head of the Cardiology Department, Sultan Idris Shah Serdang Hospital, Selangor, Malaysia
Can J Hosp Pharm, 2024;77(1):e3364.
PMID: 38204512 DOI: 10.4212/cjhp.3364

Abstract

BACKGROUND: 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.

OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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