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 2121 patients with HFrEF seen in 2022 in 4 community-based cardiology-practice sites that contained an embedded interdisciplinary HF team. After excluding 203 patients with missing data or encounters, GDMT prescribing was compared among those with (n = 1029) and without (n = 889) the support of the interdisciplinary HF teams. Patients were 33% female, 34% Black/African American, with an 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 inhibitors [ARNis] (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.