Implementation of a Multidisciplinary Inpatient Cardiology Service to Improve Heart Failure Outcomes in Guyana.
J Card Fail. 2018 Jul 13;:
Authors: Klassen SL, Miller RJ, Hao R, Warnica JW, Fine NM, Carpen M, Isaac DL
BACKGROUND: Guyana is a small developing country with a high burden of cardiovascular disease and extensive barriers to optimal care delivery. We investigated the effectiveness of a newly established multidisciplinary inpatient cardiology service in this setting.
METHODS: We performed an interrupted time-series cohort study of heart failure (HF) patients admitted to the Georgetown Public Hospital Corporation from January to December 2015 and July 2016 to December 2017. The primary outcome was discharge on guideline directed medical therapy (GDMT). Secondary outcomes included length of hospitalization and all-cause mortality.
RESULTS: We identified 740 patients, 347 (46.9%) of whom were admitted after service implementation. The post-implementation cohort was more likely to be discharged on a beta-blocker (66.6% vs 41.7%, p<0.01) and mineralocorticoid receptor antagonist (31.7% vs 15.3%, p=0.01). They were also more likely to receive echocardiograms (60.8% vs 40.5%; p<0.01) and chest x-rays (70.6% vs 46.6%; p<0.01). Hospitalization length (10.0±13.1 vs 9.8±10.1 days) and re-admissions within 90 days (19.0% vs 19.1%) were not significantly different. There was a lower number of deaths in the post-implementation cohort compared to the pre-implementation cohort (12/347 vs 28/393).
CONCLUSION: Establishment of a multidisciplinary inpatient cardiology service demonstrated increased adherence to GDMT without extending length of hospitalization.
PMID: 30012360 [PubMed – as supplied by publisher]