Abstract 17603: Integration of an Advanced Heart Failure Pathway in a Rural Community-based Multispecialty Practice
Introduction: AHF patients and their families often deal with depression, ↓ social support, and end-of-life decisions. The 2009 HF Guidelines called for supportive care (symptom management, QOL) to be incorporated as a "key component" in a patient’s plan of care. However, supportive patient-focused evidence-based care is not well integrated into the AHF patient’s usual plan of care, particularly in rural multi-specialty community-based practices (RMCBP) where care is often delivered in silos and access to specialty HF clinics is rare. 1-3
Purpose: The purpose of this QI/pilot project was to implement an integrated AHF Pathway [stage/classify HF, ↑ patient shared-decision making and symptom management] into a RMCBP.
Methods: Practice improvement/pilot project. Patients with HF who presented to the RMCBP in southern Georgia were recruited to participate. A template to stage HF was embedded in the EMR for physicians to stage HF as part of the routine visit. Patients who were Class C/D were referred to the NP for bi-weekly HF clinic visits [focused physical/psychosocial assessment, review of meds, HF education, goal-setting]. Recruitment and retention was tracked. Physiologic symptoms and quality of life measures were collected pre and post surveys: MLHFQ and Rand PSQ-18. IRB approval was obtained.
Results: N=164 HF patients presented to the RMCBP seen by both IM and Cardiology (37% staged) during the 3 month pilot. 15% (n=20) were referred to NP-led AHF clinic; 80% had LVEF <39%, mean age (62 years) gender (male 70%). Pre/post measures demonstrated improvements in 6MW (333ft vs. 387ft; p=.001), sleep (363min vs. 402min; p<.001), Quality of care scores improved; MLHFQ (41.7 vs. 37.9; p<.001) and PSQ-18 (3.43 vs. 4.45; p=0.05). During the 3-mo intervention preventable hospitalizations were fewer in the NP-AHF group compared to usual care (0.1% vs. 12%).
Conclusions: These data suggest that it is possible to engage physicians in a rural community-based multi-specialty practice to stage and refer AHF patients and that the integration of this care pathway led to improved symptom management and QOL for participants. This has implications for AHF patients who live in rural areas often far from academic teaching centers and specialty HF clinics.
Author Disclosures: B. Cohen: None. J.L. Cohen: None. E.M. Stuart-Shor: None.
- © 2014 by American Heart Association, Inc.