Shared Medical Appointments in Heart Failure For Post-hospitalization Follow-up: A Randomized Controlled Trial

Abstract

AbstractBackgroundShared medical appointments (SMAs) in heart failure (HF) are medical visits where several patients with HF meet with multidisciplinary providers at the same time for efficient and comprehensive care. It is unknown whether HF-SMAs can improve overall and cardiac health status for high-risk patients discharged with HF.MethodsA 3-site, open-label, randomized-controlled-trial was conducted. Participants within 12 weeks of HF hospitalization were randomized to receive either HF-SMA or usual HF clinical care (usual-care) on a 1:1 ratio. The HF-SMA team, which consisted of a nurse, nutritionist, psychologist, nurse practitioner and/or a clinical pharmacist, provided four 2-hour session HF-SMAs that met every other week for 8 weeks. Primary outcomes were the overall health status measured by EQ5D-VAS and cardiac health status by KCCQ, 180 days post-randomization.ResultsOf the 242 patients enrolled (HF-SMA n=117, usual-care n=125, mean age 69.3±9.4 years, 71.5% white, 94.6% male), 84% of participants completed the study (n=8 HF-SMA and n=9 usual-care patients died). After 180 days, both HF-SMA and usual-care participants had similar and significant improvements from baseline in KCCQ, but only HF-SMA participants had significant improvements in EQ5D-VAS (mean change = 7.2 ± 15.8 in HF-SMA versus -0.4 ± 19.0 points in usual-care, p<0.001).ConclusionBoth HF-SMA and usual care in HF participants achieved significant improvements in cardiac health status, but only a team approach through HF-SMA achieved significant improvements in overall health status. A larger population and a longer follow-up time are needed in future studies to evaluate re-hospitalization and death outcomes.Clinical PerspectiveThis randomized controlled trial represents the first multi-site study to rigorously assess the outcomes of a multidisciplinary team intervention in a group medical clinic setting to improve patient-centered self-reported outcomes of high-risk patients with a recent heart failure hospitalization.Shared medical appointments can improve cardiac specific and overall health status in high-risk patients with heart failure.