Impact of Embedded Interdisciplinary Heart Failure Teams on Achieving Guideline-Directed Medical Therapy Within Community-Based Cardiology Practices.

Abstract

Background: Guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF) is under-prescribed. Real-world data regarding contemporary GDMT prescribing and the impact of scalable interdisciplinary heart failure (HF) teams are needed.

Methods and results: We retrospectively identified n=2,121 patients with HFrEF seen in 2022 among four community-based cardiology practice sites that contained an embedded interdisciplinary HF team. After excluding n=203 patients with missing data or encounters, GDMT prescribing was compared among those with (n=1,029) and without (n=889) the support of the interdisciplinary HF teams. Patients were 33% female, 34% Black/African American, with average age of 69 years. Patients seen by interdisciplinary HF teams achieved more comprehensive GDMT regimens compared to patients receiving routine care alone, as shown by higher 4-Pillar Intensification Scores (6.5 vs 4.7; p<0.001). Using multivariable logistic regression models, patients whose care included an interdisciplinary HF team had higher odds (OR; 95% CI) of receiving sodium-glucose cotransporter-2 inhibitors [SGLT2is] (3.08; 2.37-3.99), angiotensin receptor/neprilysin inhibitor [ARNi] (1.84; 1.45-2.35), and mineralocorticoid receptor antagonists [MRAs] (1.41; 1.11-1.8) than patients receiving routine care alone.

Conclusions: Access to embedded interdisciplinary HF teams within community cardiology practices was associated with improved GDMT prescribing, supporting broader adoption of interdisciplinary care models for optimizing GDMT.