SHM Converge Scientific Abstract ePoster Gallery-Heart Failure Showdown: Investigating Differences in the Management of Acute Heart Failure Exacerbations Between Cardiology and Hospital Medicine Services at a Tertiary Care Center

Heart Failure Showdown: Investigating Differences in the Management of Acute Heart Failure Exacerbations Between Cardiology and Hospital Medicine Services at a Tertiary Care Center

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This retrospective study examined 73 patients hospitalized in August 2024 for heart failure exacerbation requiring IV diuretics at Thomas Jefferson University Hospital, comparing outcomes between primary cardiology (CV) and hospital medicine (HM) services.<br /><br />Among the patients, 48 (66%) were cared for by cardiology and 25 (34%) by hospital medicine. The study evaluated mortality, readmission, adequacy of diuresis, guideline-directed medical therapy (GDMT) at discharge, and outpatient follow-up.<br /><br />Key findings:<br />- Mortality was 6.3% for cardiology and 4.0% for hospital medicine; observed-to-expected mortality was 1.2 for cardiology and 0.58 for hospital medicine.<br />- Thirty-day readmission was lower for cardiology (13%) than hospital medicine (20%).<br />- Diuresis outcomes favored cardiology in terms of patient weight loss by discharge: 63% of cardiology patients lost weight versus 44% of hospital medicine patients. However, hospital medicine had a slightly higher rate of goal diuresis on days IV diuretics were given (38% vs 29%).<br />- For patients with HFrEF/HFimpEF, cardiology prescribed more GDMT at discharge: 20% were on all four pillars versus 10% under hospital medicine, and cardiology patients averaged more heart failure medications per patient (2.2 vs 1.6).<br />- In HFpEF/HFmrEF, cardiology more often prescribed SGLT2 inhibitors at discharge (29% vs 7%).<br />- Cardiology patients were more likely to see an outpatient cardiologist within 30 days (60% vs 40%), while hospital medicine patients were more likely to see a PCP within 30 days (28% vs 6%).<br /><br />Overall, cardiology showed better diuresis, GDMT use, and lower readmission, while hospital medicine had better observed-to-expected mortality and PCP follow-up. The authors conclude that both services have opportunities to improve and that sharing best practices across services may reduce variation and improve outcomes.

Asset Subtitle

Virginia Gonzalez

Meta Tag

Author List Alan A. Kubey, Avish Patel, Benjamin Richter, Comfort Elumogo, Joshua Riley, Katherine Freedberg, Marina Gonzalez, Meiqi Luo, Ryan Gardner, Sheraz Qamar, Virginia Gonzalez

Category Research

Concept Acute Heart Failure

Concept Guideline-Directed Medical Therapy

Concept Inpatient Diuresis

Concept 30-Day Readmission

Concept Cardiology

Distinguished Non-Finalist

Presenter Organization Department of Medicine, Thomas Jefferson University, Philadelphia, PA

Presenting Author Virginia Gonzalez

Track Quality Improvement

Keywords

heart failure exacerbation

intravenous diuretics

cardiology service

hospital medicine

readmission rates

guideline-directed medical therapy

diuresis outcomes

HFrEF

HFpEF

outpatient follow-up

Acute Heart Failure

Guideline-Directed Medical Therapy

Inpatient Diuresis

30-Day Readmission

Cardiology