2026 Southeastern Residency Conference

Title: Impact of an Inpatient Heart Failure Consult Service on Readmission Rates and Guideline-Directed Medical Therapy Prescribing: A Single-Center Pre-Post Intervention Study
Authors: Margaret Matthews, Jessica Yarbrough, Rachel Robinson
Purpose: The 2022 AHA/ACC/HFSA Heart Failure Guideline endorses the initiation, continuation, and reinitiation of guideline-directed medical therapy (GDMT) during hospitalization to improve clinical outcomes for patients with heart failure. GDMT use often varies in the hospital setting based on the patient’s clinical status, individual provider preference, concerns about transitions-of-care, and the dynamic course of acute heart failure. To standardize inpatient management and enhance GDMT optimization, our institution implemented an interdisciplinary inpatient heart failure consult service composed of an advanced heart failure cardiologist, clinical pharmacist, and nurse navigator. This study evaluated the impact of the service on 30-day readmission rates and GDMT prescribing patterns at our rural community hospital.
Methods: This single center, retrospective, pre-post intervention study included patients ≥ 18 years old admitted with a primary diagnosis of heart failure. Exclusion criteria followed the Centers for Medicare & Medicaid Services’ Hospital Readmissions Reduction Program criteria for heart failure readmissions. The pre-implementation period occurred from January 2024 to June 2024, and the post-implementation period occurred from June 2025 to November 2025. The data collected included patient demographics, renal function, heart failure type, discharging provider, GDMT changes during admission, GDMT prescribed at discharge, and documented contraindications. The primary outcome was 30-day-all-cause readmission rate. Secondary outcomes included 30-day heart failure-related readmission rate and change in GDMT from admission to discharge. Primary and secondary outcomes were compared between the pre- and post-implementation groups using descriptive statistics, with continuous data reported as means and categorical data reported as frequencies and percentages.
Results: A total of 447 patients were included in the analysis, with 254 patients in the pre-intervention group and 193 patients in the post-intervention group. Baseline demographics were similar between groups. Thirty-day all-cause readmission rates remained unchanged following implementation of the inpatient heart failure consult service (27% pre-intervention vs 27% post-intervention). Heart failure-related readmissions among readmitted patients decreased numerically from 51% in the pre-intervention group to 45% in the post-intervention group. Appropriate GDMT prescribing improved from admission to discharge in both groups, with a greater absolute improvement observed post-intervention (+38%, 36% to 74%) compared with pre-intervention (+13%, 41% to 54%). The largest post-intervention increases in individual GDMT classes were observed with mineralocorticoid receptor antagonists (+28%) and sodium-glucose cotransporter-2 inhibitors (+20%). Among post-intervention patients, 40% received a heart failure consult, with 27% readmitted within 30 days.
Conclusion: Implementation of an inpatient heart failure consult service was associated with increased use of GDMT at discharge and supported a more standardized approach to care. No difference in 30-day readmission rates was observed; however, not all eligible patients received a consult, which may have limited the overall impact of the intervention. Greater consult utilization and continued acceptance may further improve clinical outcomes, including readmissions.