Effects of Multidisciplinary Care of Heart Failure Patients at High Risk for Hospital Admission - PowerPoint PPT Presentation

Loading...

PPT – Effects of Multidisciplinary Care of Heart Failure Patients at High Risk for Hospital Admission PowerPoint presentation | free to download - id: 7cf223-NmQxY



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Effects of Multidisciplinary Care of Heart Failure Patients at High Risk for Hospital Admission

Description:

Effects of Multidisciplinary Care of Heart Failure Patients at High Risk for Hospital Admission S. Scott Sutton, Pharm.D. Associate Clinical Professor – PowerPoint PPT presentation

Number of Views:111
Avg rating:3.0/5.0
Slides: 30
Provided by: S10144
Learn more at: http://c.ymcdn.com
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Effects of Multidisciplinary Care of Heart Failure Patients at High Risk for Hospital Admission


1
Effects of Multidisciplinary Care of Heart
Failure Patients at High Risk for Hospital
Admission
  • S. Scott Sutton, Pharm.D.
  • Associate Clinical Professor
  • South Carolina College of Pharmacy
  • University of South Carolina Medical University
    of South Carolina
  • WJB Dorn Veterans Administration Medical Center
  • Columbia, South Carolina

2
Objectives
  • SCSHP Program agenda
  • Identify Characteristics of heart failure
    patients and common factors that lead to
    hospitalization of patients.

3
Research Team
  • S. Scott Sutton, Pharm.D.
  • Meg Franklin, Pharm.D., Ph.D.
  • C.E. (Gene) Reeder, RPh, Ph.D.
  • Frank Laws, M.D.
  • HF Research - Abstracts / Posters Publications
  • Effects of Multidisciplinary Care of Heart
    Failure Patients at High Risk for Hospital
    Admission
  • American Heart Association
  • University of South Carolina School of Medicine /
    Palmetto Health Biomedical Research Program
  • Drug Benefit Trends 20082054-59
  • Economic Evaluation of a Multidisciplinary
    Approach to Heart Failure Management
  • International Society for Pharmacoeconomics and
    Outcomes Research (ISPOR) 11th Annual
    International Meeting
  • Predicting Heart Failure Related Events in
    Patients Enrolled in an Outpatient Specialty
    Clinic in the VA System
  • In progress

4
Heart Failure
  • Key Concepts
  • Complex clinical syndrome
  • Dyspnea
  • Fatigue
  • Proven treatments
  • Decrease morbidity and mortality
  • Decrease health care expenditures
  • Angiotension converting enzyme inhibitors
  • Beta-blockers
  • Multidisciplinary care
  • Pharmacist

Circulation 20051121825-1852 NEJM
20033482007-2018 Arch Intern Med
19991591939-1945 Can J Cardiol 2004201205-1211
5
Heart Failure
  • Key Concepts
  • Complex clinical syndrome
  • Dyspnea
  • Fatigue
  • Proven treatments
  • Decrease morbidity and mortality
  • Decrease health care expenditures
  • Angiotension converting enzyme inhibitors
  • Beta-blockers
  • Multidisciplinary care
  • Pharmacist
  • 11,000 patients
  • ACEI and BB
  • 62 and 37

Suboptimal treatment may lead to Increased
mortality Increased healthcare expenditures
Circulation 20051121825-1852 NEJM
20033482007-2018 Arch Intern Med
19991591939-1945 Can J Cardiol 2004201205-1211
6
New York Heart Classification
  • Class I
  • no limitation is experienced in any activities
    there are no symptoms from ordinary activities.
  • Class II
  • slight, mild limitation of activity the patient
    is comfortable at rest or with mild exertion.
  • Class III
  • marked limitation of any activity the patient is
    comfortable only at rest.
  • Class IV
  • any physical activity brings on discomfort and
    symptoms occur at rest.

Circulation 20051121825-1852 NEJM
20033482007-2018
7
American College of CardiologyAmerican Heart
Association
  • Stage A
  • a high risk HF in the future but no structural
    heart disorder
  • Stage B
  • a structural heart disorder but no symptoms at
    any stage
  • Stage C
  • previous or current symptoms of heart failure in
    the context of an underlying structural heart
    problem, but managed with medical treatment
  • Stage D
  • advanced disease requiring hospital-based
    support, a heart transplant or palliative care

Circulation 20051121825-1852 NEJM
20033482007-2018
8
Heart Failure
  • Common model of treatment
  • Reactive
  • Patient perceives problem and makes appointment
    with clinician.
  • Ideal model provides continuous care coordination
    and support
  • Current HF Treatment Model
  • 12-15 million office visits
  • 6.5 million hospital bed days
  • More Medicare dollars than other single diagnosis
  • 27.9 billion in direct and indirect

Circulation 20051121825-1852 NEJM
20033482007-2018 Heart 200591849-850
9
HF - Pharmacologic Management
  • Angiotension Converting Enzyme Inhibitors
  • CONCENSUS
  • Enalapril versus placebo NYHA IV
  • SOLVD
  • Enalapril versus placebo NYHA II-IV
  • ATLAS
  • Low dose versus high dose lisinopril NYHAII-IV

NEJM 19873161429-35 NEJM 1991325293-302 Circul
ation 19991002312-8
10
HF - Pharmacologic Management
  • Angiotension Converting Enzyme Inhibitors
  • Heart Failure NYHA I-II
  • ACE Inhibitor x 1 year
  • 100 treated to prevent 1 death (number needed to
    treat - NNT)
  • Heart Failure NYHA IV
  • ACE Inhibitor x 1 year
  • 6 treated to prevent 1 death (NNT)
  • Heart Failure post MI
  • ACE Inhibitor
  • 18 treated to prevent 1 death (NNT)

NEJM 19873161429-35 NEJM 1991325293-302 Circul
ation 19991002312-8 Bandolier
11
HF - Pharmacologic Management
  • Beta-Blockers - (Number needed to treat 14-22)
  • CIBIS-II
  • Bisoprolol versus placebo NYHA III-IV
  • US Carvedilol Heart Failure Study
  • Carvediolol versus placebo NYHA II-IV
  • Merit-HF
  • Metoprolol XL versus placebo NYHA II-IV
  • COMET
  • Carverdilol versus metoprolol tartrate NYHA
    II-IV
  • Only compared to immediate release metoprolol

Lancet 19993539-13 NEJM 19963341349-55 Lancet
19993532001-7 Lancet 20033627-13
12
HF - Pharmacologic Management
Beta-Blockers
Outcome of trials Beta-blocker Control Relative risk (95 CI) NNT (95 CI)
Mortality 14 443/5366 682/4867 0.62 (0.55-0.69) 17 (14-22)
Mortality or Hospital admission 9 1401/5035 1655/4610 0.81 (0.76-0.86) 12 (10-16)
Hospital admission 13 613/5301 833/4827 0.67 (0.61-0.74) 17 (14-23)
Bandolier - http//www.jr2.ox.ac.uk/bandolier/boot
h/AF/betamort.html
13
HF - Pharmacologic Management
  • Aldosterone Antagonists
  • RALES
  • Spironolactone versus placebo NYHA III-IV
  • NNT (all-cause mortality) 10
  • EPHESUS
  • Eplerenone versus placebo acute MI with LV
    dysfunction
  • NNT (all-cause mortality) 44

NEJM 1999341(10)709-17 NEJM 20033481309-21
14
HF non-Pharmacologic Management
  • Multidisciplinary Clinics
  • Decrease mortality Rates
  • Mortality rate similar to that of ACE Inhibitors
  • Reduce hospital admission rates
  • All cause hospital admission 13
  • HF admissions by 30
  • Decrease use of health-care resources

Heart 200591899-906 Chest 200512717340-45
15
HF non-Pharmacologic Management
  • Home-based interventions
  • Decreased
  • All cause-admission
  • HF related admission
  • Mean days in the hospital
  • Telephone-based interventions
  • Decreased
  • Mortality
  • HF admissions

Heart 200591899-906
16
HF non-Pharmacologic Management
  • Randomized clinical trials based upon self-care
  • Decreased
  • Readmission
  • Hospitalization days
  • Cost of care
  • 2 key components
  • 1-to-1 patient education
  • Self-management recommendations

Heart 200591899-906
17
Effects of Multidisciplinary Care
Multidisciplinary Care Trials Patients Intervention ( having event) Control ( having event) Relative Risk (95 CI) Number needed to Treat (95 CI)
All-cause mortality 12 2129 17 24 0.7 (0.6-0.9) 17 (11-38)
All-cause Admission 14 2273 41 51 0.8 (0.7-0.9) 10 (7-16)
HF Admission 9 1416 27 38 0.7 (0.6-0.8) 9 (6-17)
Journal American College of Cardiology
200444810-819 American Journal of Medicine
2001110378-84
18
Effects of Multidisciplinary Care of Heart
Failure Patients at High Risk for Hospital
Admission
  • S. Scott Sutton, Pharm.D.
  • Meg Franklin, Pharm.D., Ph.D.
  • C.E. (Gene) Reeder, RPh, Ph.D.
  • Frank Laws, M.D.
  • Drug Benefit Trends 20082054-59 (publication)
  • American Heart Association (abstract / poster
    presentation)

19
Advanced Heart Failure Program (AHFP)
  • Target Patients
  • High readmission rates
  • Risks are identified
  • Intervention Describes
  • Strategy to improve outcomes of patients with
    chronic HF at the Dorn Veterans Administration
    Medical Center in Columbia, South Carolina

Drug Benefit Trends 20082054-59
20
Advanced Heart Failure Program (AHFP)
  • Developed to provide comprehensive
    multidisciplinary management to persons with
    advanced HF.
  • Inclusion criteria
  • ACC/AHA stage C/D or NYHA III/IV
  • Hospitalized 2 or more times in 1-year period

Drug Benefit Trends 20082054-59
21
Advanced Heart Failure Program (AHFP)
  • Goals
  • Decrease hospital admission readmission
  • Decrease health-care expenditures
  • Improve quality of life
  • AHFP Team
  • Cardiologist
  • Internal Medicine Specialist
  • Nurse Practitioner
  • Nurse
  • Case Managers
  • Physician assistants
  • Pharmacists
  • Clinical Researchers

Drug Benefit Trends 20082054-59
22
AHFP
23
Advanced Heart Failure Program (AHFP)
  • Once enrolled into AHFP
  • Patients presented every 2 weeks for first 2
    months
  • Monthly thereafter
  • Initial Visit
  • Extensive evaluation
  • Physical
  • Diagnostic
  • Laboratory
  • Medication
  • Quality of Life Evaluation

Drug Benefit Trends 20082054-59
24
AHFP Costs
Initial Visit 1051.92 Subsequent
visits 141.73 50 Week Cost 3036.14
Drug Benefit Trends 20082054-59
25
Advanced Heart Failure Program (AHFP)
  • Once enrolled into AHFP
  • Patients presented every 2 weeks for first 2
    months
  • Monthly thereafter
  • Initial Visit
  • Extensive evaluation
  • Physical
  • Diagnostic
  • Laboratory
  • Medication
  • Quality of Life Evaluation

Medication Evaluation AHFP Medications (pending
indications) Lisinopril Furosemide Carvedilol
Spironolactone Other medications potentially
utilized Digoxin Valsartan Potassium Chloride
Drug Benefit Trends 20082054-59
26
Patient Population Local versus National
P R E V A L E N C E
27
AHFP - Results
Baseline Characteristics
Hospital Readmission Rates per Patient
Drug Benefit Trends 20082054-59
28
Drug Benefit Trends 20082054-59
29
Objectives
  • SCSHP Program agenda
  • Identify Characteristics of heart failure
    patients and common factors that lead to
    hospitalization of patients.
  • Implications to clinicians
About PowerShow.com