# Presentation: 145086

## Impact of a Group Heart Failure Clinic on Patient Outcomes in a Veteran Population

***Impact of a Group Heart Failure Clinic on Patient Outcomes in a Veteran Population***

- Melissa Angell, Pharm.D., CGP
- Adrienne Matson, Pharm.D., BCPS
- Kate Schmoll, Pharm.D., PGY1 Resident
- Veterans Affairs Medical Center
- Lexington, Kentucky

**Notes:**
Impact of a Group Heart Failure Clinic on Patient Outcomes in a Veteran Population

Melissa Angell, Pharm.D., CGP
Adrienne Matson, Pharm.D., BCPS
Kate Schmoll, Pharm.D., PGY1 Resident
Veterans Affairs Medical Center
Lexington, Kentucky

## Lexington VAMC Heart Failure Clinic 

- Established in November 2005
- A collaboration between Pharmacy, Nursing, Nutrition, and Primary Care
- Group Clinic Format
- Shared Medical Appointment
- Referral from Primary Care and Cardiology

**Notes:**
Lexington VAMC Heart Failure Clinic

- Established in November 2005
- A collaboration between Pharmacy, Nursing, Nutrition, and Primary Care
Group Clinic Format: Shared Medical Appointment
Referral from Primary Care and Cardiology

## Group Clinic Consult

**Notes:**
Group Clinic Consult

## Group Heart Failure Clinic

- Patient asked to attend 4 sessions (1/month)
- Heart Failure Overview
- Medications
- Lifestyle Modifications
- Diet and Nutrition
- Group Appointment
-  ~1.5 hours
- 5-8 patients per session along with family members

**Notes:**
Group Heart Failure Clinic
Patient asked to attend 4 sessions (1/month)
-Heart Failure Overview
-Medications
-Lifestyle Modifications
-Diet and Nutrition

Group Appointment
 - ~1.5 hours
- 5-8 patients per session along with family members

## Group Clinic Visit

**Notes:**
Group Clinic Visit

## Evaluation of Clinic Outcomes

- Primary Objective:
- Evaluate the impact of a multidisciplinary group HF clinic on quality of life (Kansas City Cardiomyopathy Questionnaire)
- Secondary Objectives:
- Medication Optimization
- Heart failure related utilization of hospital resources (ED and PC visits)

**Notes:**
Evaluation of Clinic Outcomes

Primary Objective:
- Evaluate the impact of a multidisciplinary group HF clinic on quality of life (Kansas City Cardiomyopathy Questionnaire)
Secondary Objectives:
- Medication Optimization
- Heart failure related utilization of hospital resources (ED and PC visits)

## Retrospective Chart Review

| Number of Patients | n=44 |
| --- | --- |
| Mean Age | 67 years |
| Race | Caucasian - 84% / 
African American - 16% |
| Gender | Male - 100% |
| Average number of
medications at baseline | 6.6 meds/patient |
| Average EF at baseline | 34% |
| Average BNP at baseline | 358 pg/ml |

**Notes:**
Retrospective Chart Review

## Results – Quality of Life

**Kansas City Cardiomyopathy Questionnaire:**
**Result Summary Table**

| 
Domain | Baseline to 2nd clinic visit        
(p value)
n=44 | Baseline to 3rd clinic visit
(p value)
n=37 | Baseline to 4th clinic visit
(p value)
n=32 | Baseline to 5th clinic visit
(p value)
n=12 |
| --- | --- | --- | --- | --- |
| Quality of Life | 0.563 | 0.265 | 0.144 | 0.0117 |
| Physical Limitation | 0.053 | 0.008 | 0.006 | 0.420 |
| Overall Summary Score | 0.076 | 0.004 | 0.003 | 0.002 |

**Notes:**
Results – Quality of Life
Kansas City Cardiomyopathy Questionnaire: Result Summary Table

## Results - Medication Optimization

- ACE inhibitor/ARB Therapy
- Optimization

**Notes:**
Results - Medication Optimization

## Results - Medication Optimization

- Beta Blocker Therapy Optimization

**Notes:**
Results - Medication Optimization

## Results - Medication Optimization

**ACEI / ARB therapy**
- 34% of patients at goal at baseline
- 82% at goal after (or titrated to max effect without ADEs)
- p - <0.001
**Beta blocker therapy**
- 19% of patients at goal at baseline
- 65% at goal after (or titrated to max effect without ADEs)
- p - <0.001

**Notes:**
Results - Medication Optimization

- ACEI / ARB therapy
- 34% of patients at goal at baseline
- 82% at goal after (or titrated to max effect without ADEs) p - <0.001 

- Beta blocker therapy
- 19% of patients at goal at baseline
- 65% at goal after (or titrated to max effect without ADEs) p - <0.001

Actual p value for ACE – 0.0025, Beta blocker – 0.000475

## Results- PC and ED visits

**Statistically significant decrease in combined HF related PCP and ED visits**** (p - 0.001)**
- Compared # of visits in 365 days prior to initial HF group visit vs. # of visits in 365 days following first group clinic visit

**Notes:**
Results- PC and ED visits

- Statistically significant decrease in combined HF related PCP and ED visits (p - 0.001)

- Compared # of visits in 365 days prior to initial HF group visit vs. # of visits in 365 days following first group clinic visit

## Lessons Learned

- Resources and Support (up front)
-  Group clinic room with space for wheelchairs
- Clinic Facilitator (scheduling, room preparation, educational packets.....)
-  Group Clinic Documenter (enters notes in CPRS during clinic)
- Staff Coverage
- Identify patients appropriate for group clinic appointments

**Notes:**
Lessons Learned

- Resources and Support (up front)
 - Group clinic room with space for wheelchairs
- Clinic Facilitator (scheduling, room preparation, educational packets.....)
 - Group Clinic Documenter (enters notes in CPRS during clinic)
Staff Coverage

- Identify patients appropriate for group clinic appointments

## Time for Questions

**Notes:**
Time for Questions