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

Background Heart failure care and education require a multifaceted approach to ensure appropriate transition from inpatient to outpatient care. Aims 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). Methods 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. Results 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. Conclusions 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.