2026 Southeastern Residency Conference

Authors: Joan M. Jakab, William W. Feese, Mitchell S. Hutson, A. Shaun Rowe, & Kaylee W. Behal 
Background: Patients with heart failure have complex medication regimens, often involving a need for additional education and care. Multidisciplinary care improves medication adherence and dose optimization of the four pillars of heart failure therapy. Outpatient multidisciplinary integration in heart failure clinics has shown enhanced medication optimization and reduced hospital admission thus the need to assess inpatient multidisciplinary care. The purpose of this study is to evaluate the impact of a multidisciplinary cardiology-focused unit on guideline directed medical therapy (GDMT) at hospital discharge for patients with heart failure with reduced ejection fraction (HFrEF). 
Methods: This retrospective cohort study examines 364 patients with HFrEF grouped according to discharge location from either the cardiology-focused multidisciplinary unit or any other   unit. Multidisciplinary cardiology-focused units receive heart failure education tailored to each specialty such as disease specific education courses for registered nurses, importance of intake and output documentation, daily weights, and movement by exercise physiology. The primary outcome is GDMT score at discharge. Secondary outcomes include the change in GDMT score from admission to discharge and the percentage of pillars of therapy on each patient’s medication regimen. The subgroup analysis includes pharmacist initiation of GDMT as determined by clinical intervention documentation in the electronic medical record. The secondary safety endpoint includes hospital readmissions at 30 or 90 days.  
Results: At discharge, patients admitted to the multidisciplinary cardiology-focused unit achieved higher GDMT scores compared with patients admitted to other units (5 [2, 6] vs. 3 [1, 5]; p=0.0003). The change in GDMT scores from admission to discharge was significantly greater in the cardiology unit (1 [0, 5] vs. 0 [0, 1]; p<0.0001). Patients discharged from cardiology-focused units had a higher number of GDMT medications prescribed (3 [2, 4] vs. 2 [1, 3]; p=0.0005). Thirty or ninety day heart failure-related readmission rates were similar between groups (8 [6.4%] vs. 13 [5.4%]; p=0.7089). Patients admitted to cardiology-focused units were more likely to have at least one heart failure-related pharmacist clinical intervention during admission (61 [48.8%] vs. 63 [26.4%]; p<0.0001; OR 2.7, 95% CI 1.7–4.2). 
Conclusions: In this retrospective study, patients with HFrEF who were admitted to the multidisciplinary cardiology-focused unit had higher GDMT scores at discharge indicating greater optimization of GDMT. These findings suggest that a multidisciplinary team plays a critical role in identifying gaps in therapy and promoting evidence-based medication optimization during hospitalization.