SHM Converge Scientific Abstract ePoster Gallery-Congestive Heart Failure: Dedicated Cardiovascular Hospitalists Service vs Traditional Hospitalists

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This retrospective cohort study compared outcomes for inpatient congestive heart failure (CHF) admissions managed by a dedicated cardiovascular (CV) hospitalist service versus traditional hospitalist care across 12 Intermountain Health hospitals from December 2018 to December 2022.<br /><br />CHF hospitalizations are costly and associated with high 30-day readmission and mortality. Intermountain’s CV hospitalist service grew from 1 FTE in 2005 to 18 FTE by 2023, and the study evaluated whether this specialized model improved outcomes.<br /><br />The analysis included 5,694 CHF inpatient encounters discharged home or to SNF/LTACH, excluding interhospital transfers. The primary outcome was combined all-cause 30-day readmission or mortality. Patients were classified by the primary discharging team. Models adjusted for age, sex, race/ethnicity, insurance, Charlson Comorbidity Index, ejection fraction, ICU stay, and length of stay.<br /><br />Key findings:<br />- Patients cared for by CV hospitalists had a lower rate of the combined 30-day readmission/mortality outcome.<br />- Although they had more advanced heart failure characteristics, they were younger, had similar comorbidity burden, lower ejection fractions, less ICU utilization, and longer hospital stays.<br />- After adjustment, CV hospitalist care was associated with a 16.7% reduction in the odds of the primary outcome.<br />- Mixed-effects modeling (OR 0.82, p=0.034) and propensity matching (OR 0.76, p=0.002) confirmed the benefit.<br />- Medicare/Medicaid insurance, higher Charlson score, ICU stay, and longer encounter length of stay were associated with higher odds of readmission or mortality.<br /><br />Overall, the study suggests that a mature dedicated CV hospitalist service is associated with better short-term CHF outcomes compared with traditional hospitalist care, even among patients with more advanced disease.

Asset Subtitle

Harris L. Carmichael

Meta Tag

Author List Harris L. Carmichael, Kirk Knowlton, Lana McGill, Michael Pirozzi, Monique Mahlum, Rajendu Srivastava, Rami Alharethi

Category Research

Concept Heart Failure

Concept 30-Day Readmission

Concept Cardiovascular Hospitalist Service

Concept Hospital Admission

Concept Mortality

Distinguished Non-Finalist

Presenter Organization Intermountain Healthcare

Presenting Author Harris L. Carmichael

Track Outcomes Research

Keywords

congestive heart failure

cardiovascular hospitalist

hospitalist care

30-day readmission

mortality

retrospective cohort study

heart failure outcomes

Intermountain Health

propensity matching

ejection fraction

Heart Failure

30-Day Readmission

Cardiovascular Hospitalist Service

Hospital Admission

Mortality