Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.
Open Heart. 2022 Jul;9(2). doi: 10.1136/openhrt-2022-001979.
Heart failure (HF) is associated with comorbidities which independently influence treatment response and outcomes. This retrospective observational study (January 2020-June 2021) analysed the impact of monthly HF multispecialty multidisciplinary team (MDT) meetings to address management of HF comorbidities and thereby on provision, cost of care and HF outcomes.
Patients acted as their own controls, with outcomes compared for equal periods (for each patient) pre (HF MDT) versus post-MDT (multispecialty) meeting. The multispecialty MDT comprised HF cardiologists (primary, secondary, tertiary care), HF nurses, nephrologist, endocrinologist, palliative care, chest physician, pharmacist, clinical pharmacologist and geriatrician. Outcome measures were (1) all-cause hospitalisations, (2) outpatient clinic attendances and (3) cost.
334 patients (mean age 72.5±11 years) were discussed virtually through MDT meetings and follow-up duration was 13.9±4 months. Mean age-adjusted Charlson Comorbidity Index was 7.6±2.1 and Rockwood Frailty Score 5.5±1.6. Multispecialty interventions included optimising diabetes therapy (haemoglobin A1c-HbA1c pre-MDT 68±11 mmol/mol vs post-MDT 61±9 mmol/mol; p<0.001), deprescribing to reduce anticholinergic burden (pre-MDT 1.85±0.4 vs 1.5±0.3 post-MDT; p<0.001), initiation of renin-angiotensin aldosterone system inhibitors in HF with reduced ejection fraction (HFrEF) with advanced chronic kidney disease (9% pre vs 71% post-MDT; p<0.001). Other interventions included potassium binders, treatment of anaemia, falls assessment, management of chest conditions, day-case ascitic, pleural drains and palliative support. Total cost of funding monthly multispecialty meetings was £32 400 and resultant 64 clinic appointments cost £9600. The post-MDT study period was associated with reduction in 481 clinic appointments (cost saving £72150) and reduced all-cause hospitalisations (pre-MDT 1.1±0.4 vs 0.6±0.1 post-MDT; p<0.001), reduction of 1586 hospital bed-days and cost savings of £634 400. Total cost saving to the healthcare system was £664 550.
HF multispecialty virtual MDT model provides integrated, holistic care across all healthcare tiers for management of HF and associated comorbidities. This approach is associated with reduced clinic attendances and all-cause hospitalisations, leading to significant cost savings.
心力衰竭（HF）与合并症相关，这些合并症独立影响治疗反应和结局。本回顾性观察研究（2020 年 1 月至 2021 年 6 月）分析了每月 HF 多学科多专业团队（MDT）会议的影响，以解决 HF 合并症的管理问题，从而影响提供、护理成本和 HF 结局。
患者作为自己的对照，在相等的时间段内（每位患者）比较 MDT 会议前后（HFMDT）的结果（多学科）。多学科 MDT 包括 HF 心脏病专家（初级、二级、三级护理）、HF 护士、肾病专家、内分泌专家、姑息治疗专家、胸部医师、药剂师、临床药理学家和老年病学家。结局指标为：（1）全因住院，（2）门诊就诊次数，（3）成本。
334 名患者（平均年龄 72.5±11 岁）通过 MDT 会议进行了虚拟讨论，随访时间为 13.9±4 个月。平均年龄调整后的 Charlson 合并症指数为 7.6±2.1，Rockwood 脆弱性评分 5.5±1.6。多学科干预措施包括优化糖尿病治疗（HbA1c 从 MDT 前的 68±11mmol/mol 降至 MDT 后的 61±9mmol/mol；p<0.001），减少抗胆碱能药物负担（MDT 前 1.85±0.4 与 MDT 后 1.5±0.3 相比；p<0.001），在射血分数降低的心力衰竭（HFrEF）合并慢性肾脏病（CKD）进展时开始使用肾素-血管紧张素-醛固酮系统抑制剂（MDT 前 9%与 MDT 后 71%相比；p<0.001）。其他干预措施包括使用钾结合剂、治疗贫血、评估跌倒、处理胸部疾病、日间腹水引流、胸腔引流和姑息治疗支持。每月多学科会议的总费用为 32400 英镑，64 次就诊的费用为 9600 英镑。MDT 后研究期间，减少了 481 次就诊（节省 72150 英镑）和全因住院（MDT 前 1.1±0.4 与 MDT 后 0.6±0.1 相比；p<0.001），减少了 1586 个住院日和节省了 634400 英镑。该方法为医疗系统总共节省了 664550 英镑。
HF 多学科虚拟 MDT 模式为 HF 及其相关合并症的管理提供了跨越所有医疗保健层级的综合、整体护理。这种方法与减少就诊次数和全因住院有关，从而显著节省成本。
