Q&A: Multidisciplinary teams key to managing patients with HF
The CDC estimates that 6 million Americans are diagnosed each year with HF, and that it is responsible for more than 300,000 U.S. deaths per year and costs the U.S. health system more than $30 billion annually.
Fortunately, new treatments have emerged to help improve survival and quality of life and reduce hospital readmission in patients with HF.
Sandra V. Chaparro, MD, director of the Advanced Heart Recovery Program at Baptist Health’s Miami Cardiac & Vascular Institute, and colleagues are one team that has developed best practices, including the establishment of a multidisciplinary approach to treating patients with HF that help them live longer and have a better quality of life.
Chaparro spoke with Healio about the various treatment methodologies for patients with HF, including for those who were previously diagnosed with COVID-19.
Healio: You advocate that a dedicated team should be formed. Who should be on it?
Chaparro: It has to be a team of providers with different levels of expertise that use a multidisciplinary approach. Ideally, the best members of the team are nurses, nurse practitioners, dietitians, pharmacists, social workers and psychologists. The core team should be nurse practitioners working with the nurses.
Healio: What specialties should be involved in a multidisciplinary approach to HF treatment, and what is the best way for them to interact with each other?
Chaparro: As I mentioned before, the most important members are the nurses, nurse practitioners in addition to the pharmacists and dietitians. The interaction among the members should include a weekly meeting where the team reviews all the patients from both the inpatient and the outpatient perspective. That would be the ideal. Between meetings, it is important to have good communication. It could be a telephone call or through the electronic medical record.
Healio: Home monitoring is an important part of HF care. What procedures and policies can be used to maximize this?
Chaparro: In terms of home monitoring, it is very important to identify the patients who are at higher risk and who would be compliant with the program. We have an inclusion and exclusion criteria list to identify which patients are going to be compliant. There are a lot of remote monitoring devices that can give you a lot of information about vital signs, but if the patient is not proactive, not following instructions, not answering calls and not taking the medicines, then the home monitoring program is not going to work. The best way to use home monitoring is to have pathways and algorithms for members of the medical team to use in different clinical scenarios.
Healio: How can the health care team get the patient’s social support system involved? What can the health care team do when the patient does not have much of a social support system (or any at all)?
Chaparro: It starts with the first encounter with the patient. Let’s say that the patient has been admitted to the hospital. During history and physical exam, you start asking those questions such as: Where are you living? Who are you living with? Who helps you with your medications? What kind of transportation do you have? Sometimes the case managers and social workers get involved early so they can establish who is the appropriate social support person to whom they can reach out to help the patient at home. They need to find options when the patient does not have a social support system. During the pandemic, many patients lost insurance and they did not have resources. In that case, you had to be creative and work with the county. We work outside our health system with a clinic that can see patients that do not have a lot of social support; for example, patients who do not have insurance. We make sure that we make that transition.
Working in conjunction with the social worker and the case managers is important, so that they know the right resources for the specific case. For example, we have situations where the patients are homeless so they can reach out to shelters if the patient lives in Miami-Dade County. We have the county hospital that provides some of the medicines free. We’d communicate with members of the team that are coming up with these resources.
Healio: What treatments should form the core of a HF program?
Chaparro: The most important one is behavioral change. Lifestyle modification: For example, stop smoking, diet, weight loss and exercise. In addition to that, a program needs to follow medical therapy guidelines based on the condition of the patient.
Healio: What impact has the COVID-19 pandemic had on patients with HF and on HF programs? What are the best ways to treat patients with HF and COVID-19?
ro: During the pandemic, a lot of the patients with HF were afraid of being in the hospital facility. So, there were a lot of missed appointments. Patients were not getting their medicines refilled; they were afraid of getting out of their house. We noticed that a lot of the patients were waiting too long to be seen and we missed the opportunity to make changes. Patients coming to the hospital in a dire situation, in worse shape with more compromised organs, was one of the consequences of the pandemic, especially in the summer.
In the acute phase, the patient who has HF and presents with COVID-19 is at high risk for complications.
We already learned a lot of things about COVID-19 and CVD, so those patients will get blood tests to check for biomarkers, and they will get imaging studies and an echocardiogram to make sure their heart condition is stable.
Based on their circumstances, they will get scans and further interventions because we know that patients with HF and COVID-19 can have worse outcomes than a person that doesn't have HF.
Once a patient is out of the hospital, then we have to make sure that we transfer them to the outpatient setting and that the transition is smooth. We need to establish patient care management programs.
It’s important that patients have their medicines and are stable, and then we follow them in the recovery program until they improve and are ready to go back to a normal condition.
For more information:
Sandra V. Chaparro, MD, can be reached at sandrach@baptisthealth.net.
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