Approaches for Managing Patients With Heart Failure
In this video, cardiologists Seth Martin, MD, MHS, and Jessica Golbus, MD, speak with Sarah Riley, MSN, CRNP, CHFN, and Michael Dorsch, PharmD, MS, in a roundtable discussion on the role of a multidisciplinary approach in the management of patients with heart failure, including current guidelines and how a multidisciplinary approach can positively impact patient care.
Additional Resource:
- Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):e263-e421. doi:10.1016/j.jacc.2021.12.012
Seth Martin, MD, MHS, is a professor of medicine in the Division of Cardiology at Johns Hopkins University School of Medicine (Baltimore, MD). Dr Martin cares for inpatients at Johns Hopkins Hospital and also has an outpatient clinic. He directs the Digital Health Lab at the Ciccarone Center for the Prevention of Cardiovascular Disease and serves as the center director of the mTECH Center, part of the AHA Health Tech and Innovation Network, and a co-founder of Corrie Health, Inc.
Jessica Golbus, MD, is a clinical instructor in the Division of Cardiovascular Medicine at the University of Michigan and specializes in heart failure, heart transplantation, and mechanical circulatory support (Ann Arbor, MI).
Sarah Riley, MSN, CRNP, CHFN, is a certified nurse practitioner at the Johns Hopkins Hospital and specializes in managing patients diagnosed with heart failure at the Johns Hopkins Heart Failure Bridge Clinic and Center for Heart Failure with Preserved Ejection Fraction (Baltimore, MD).
Michael Dorsch, PharmD, MS, is an associate professor, pharmacist, and clinical researcher who studies health information technology's effects on cardiovascular disease outcomes at the University of Michigan College of Pharmacy (Ann Arbor, MI).
TRANSCRIPTION:
Seth Martin, MD:
All right. Thank you all for joining us for a multidisciplinary discussion on heart failure. I'm Seth Martin, I'm a cardiologist at Johns Hopkins, and I have the pleasure of serving as the Center Director in our HA Health Tech Network where we have a collaborative project focused on heart failure. I'm going to go around and introduce our other experts. Sarah, do you want to start?
Sarah Riley, MSN, CRNP, CHF:
Sure. Hi, my name is Sarah Riley. I'm a nurse practitioner at Johns Hopkins. I work in our Heart Failure department with the Division of Cardiology, and we work in the Heart Failure Bridge Clinic, which bridges the gap between hospital discharge and home, with patients with a diagnosis of heart failure. And I also work with our advanced heart failure folks awaiting transplant.
Seth Martin, MD:
Thank you for joining. Sarah. Jessie, you want to go next?
Jessica Golbus, MD:
Hi, I am Jessie Golbus, and I'm a heart failure and transplant cardiologist at the University of Michigan. And, I'm really interested in how we can use mobile health technologies for behavioral modification for patients with cardiovascular disease, with a particular interest in applying that to heart failure. So as part of that, I'm also part of our AHASFRN on Health Technologies in Innovation, in which we're doing a collaborative project looking at implementation of GDMT using mobile health technologies.
Seth Martin, MD:
Awesome. Thanks, Jessie. And then Mike.
MIke Dorsch, PharmD, MS:
Hi, I'm Mike Dorsch, I'm a pharmacist. I'm a clinical researcher at the University of Michigan College of Pharmacy, and also the University of Michigan Cardiovascular Center. I'm also a member of the Health Tech SRN through the American Heart Association in researching GDMT and heart failure.
Seth Martin, MD:
Great, thanks Mike. So, I'm looking forward to an exciting discussion. We have a couple of institutions represented here, and then we have physicians, nursing, and the pharmacist side of things represented here. So, I'm looking forward to this multidisciplinary discussion. So, let's just dive right in with the role of the multidisciplinary approach in the management of heart failure. So, Sarah, perhaps you could lead us off by describing the role of the multidisciplinary approach in the management of heart failure, what has been your experience in leveraging that type of approach in the Heart Failure Bridge Clinic at Hopkins?
Sarah Riley, MSN, CRNP, CHF:
Sure. Thanks, Seth. So, as I said, we work in the Heart Failure Bridge Clinic, so we see a lot of patients coming out of the hospital with a new diagnosis of heart failure, or perhaps a recurrent admission. And so a lot of times we work with the multidisciplinary team to optimize the care for all these patients. We have a pharmacist that we're able to touch base with when trying to get patients on optimal GDMT. We also have a community health worker, with whom we're able to get into the community to really help these patients navigate their barriers with receiving their optimal care.
And then as far as the physicians, we're able to touch base with all of our physicians, and a lot of these patients actually have yet to be established with cardiologists. So one of our main goals is getting them the longitudinal care they need to be able to implement everything to optimize their care, which I think is very important. And of that importance is also communicating with all these people, which I think is often tough for the patient to do on their own. So we're able to provide them with different methods and ways to communicate with all these providers and make sure that we're all working together towards the same goal.
Seth Martin, MD:
Thanks, Sarah. That's a really clear and concise description. And, maybe I can turn it over to you next, Jessie, to dive into this multidisciplinary approach a bit more, the why behind it. Why is this so important for our patients with heart failure?
Jessica Golbus, MD:
Yeah. Well, frankly, I couldn't do my job without a multidisciplinary approach, and really relying on everyone else's expertise. It is so essential. And the problem of heart failure is so massive, that no one person could singly tackle the issue. So you have issues with medication management and guideline-directed medical therapy. You have nutrition, you have social support. You have all the self-care that goes into heart failure. And there is frankly just no one person that could address all of this. And we actually know that a multidisciplinary approach improves outcomes. So, we've shown that through randomized controlled trials and meta-analysis that if you have a multidisciplinary approach, it reduces hospitalizations, it improves patient's quality of life. So, it really has been borne out in the data that a multidisciplinary approach is essential to improving heart failure care.
Seth Martin, MD:
Thank you so much, Jessie. And those data that you're speaking of have made their way into guidelines, and increasingly we've seen guidelines acknowledge the role of multidisciplinary teams in delivering heart failure care. So Mike, maybe you can inform us some more about current guidelines and what they say about the role of a multidisciplinary approach in heart failure care.
MIke Dorsch, PharmD, MS:
Yeah, sure. So the 2022 guidelines support multidisciplinary care. And one of the things that they talk a lot about are the things that Jessie mentioned, but also the significant amount of comorbidities that patients with heart failure have. Not only do they have heart failure, but they probably have a slew of other diseases that have come from having heart failure. Or, the long process of having heart failure, they have other cardiovascular diseases. So, it really helps to have that multidisciplinary approach because they could be treated for their diabetes or for their coronary disease and have drugs that maybe interact or other things that may be helping or hurting the patient. You have all those people around you to help you through that.
Seth Martin, MD:
Mike, thanks so much. Yeah, that comorbidity piece is so key, and it does speak to the multidisciplinary approaches happening within cardiology, nurses, pharmacists, and physicians, but also interfacing with endocrinology and other subspecialties that are involved in their care. And, this approach really can help positively impact patient care. So, if we can avoid this siloing of care and patients feeling, "Who's taking ownership, who's really helping me?" and actually come together as a unified team supporting that patient. And Sarah, maybe you could speak about your experience in The Heart Failure Bridge Clinic and what you've seen in terms of positive patient outcomes. You may have some patients or families that you've worked with now over the years that you've really seen that positive impact. We'd love to get your insights.
Sarah Riley, MSN, CRNP, CHF:
Sure. So our goal in the Bridge Clinic is to prevent hospital readmissions. We're able to actually see the patient on a weekly, or every weekly, or whatever we determine basis, to get these patients the care that we need, which is nice because we have the time to be able to spend with them and bring them back so quickly. And so a lot of these patients that we've taken care of have actually become patients for us years beyond just that initial heart failure hospitalization. And they say, "It's so great having this resource to be able to contact you when I feel as though I may be tipping into volume overload or heart failure, and I don't want to go into the hospital." And so, the relationships that we've made with these patients are awesome, and they expand throughout the years, like I said, with the goal of trying to prevent them from being hospitalized again.
Seth Martin, MD:
Thanks, Sarah. Well, I think this has been a really great discussion on the importance of multidisciplinary care for our heart failure patients, and really thank each of you for your time, and thank you for everything you've done for your patients, as well as to move the world of cardiovascular medicine and heart failure care forward. Thank you