The Value of Multidisciplinary Heart Failure Programs. Joseph G. Rogers, MD Professor of Medicine Division of Cardiology Duke University

Transcription

1 The Value of Multidisciplinary Heart Failure Programs Joseph G. Rogers, MD Professor of Medicine Division of Cardiology Duke University

2 The Epidemiology of Heart Failure in the United States American Heart Association Heart and Stroke Statistical Update J Am Geriatr Soc 45:

3 Estimated Direct and Indirect Costs of HF in US Hospitalization $ % Total Cost $39.2 billion 11.9% Nursing Home $4.7 Lost Productivity/ Mortality* $ % Home Healthcare $ % 8.2% 6.4% Physicians/Other Professionals $2.5 Drugs/Other Medical Durables $3.2 Circulation, Feb 2010; 121: e46 - e215

4 Redesigning Heart Failure Care

5 Readmissions Following Heart Failure Admission Total Non-Heart Failure Heart Failure Am J Med 2016 in press

6 Multidisciplinary Care - How will I afford my medications? - Will I be able to work? - Can I exercise? - Who should I call if I have trouble? - Am I using the best medications? - What co-morbidities should I treat? - Does he need to see a surgeon? - How often should I see him?

7 Eur J Heart Fail 2016;18:759-61

8 Advances in Heart Failure Monitoring Low Tech High Tech

9 Question The CHAMPION trial demonstrated the following: A. Patients with an implanted hemodynamic monitor did not derive benefit because of device and implant related complications B. Patients with an implanted hemodynamic monitor actually experienced more frequent hospitalizations because of heightened monitoring C. Patients with hemodynamic monitoring had fewer hospitalizations than those whose hemodynamics were not monitored D. The trial was stopped prematurely because of device failures

10 Pulmonary Artery Pressure Monitoring CHAMPION 550 patients with chronic heart failure GDMT NYHA Class III One HF hospitalization in the past 12 months All received Cardiomems Randomized to active intervention or standard care Preserved or reduced EF Lancet 2011;377:658-66

11 Champion ICER report: exceeds value-based price September 11, 2015 Lancet 2011;377:658-66

12 Care Delivery Innovations Apple HealthKit B. B. C. Apple C. Health Apple App Health Interface App Interface ata Flow. A) Patient is seen by health provider and o study. B) Patient provided with JawboneUp24, Withings cale, ihealth BP cuff, and ipod with Health App. C) The lects e 1. Data each health Flow. monitor A) Patient (s) that is seen they by would health like to provider allow and tion nts into study. HealthKit B) Patient where through provided the with Health JawboneUp24, App, they Withings ess ze data scale, under ihealth one dashboard. BP cuff, and D) The ipod provider with Health places a App. C) The EPIC for patient to share their data; the patient, through nt selects each health monitor (s) that they would like to allow selects any Health data they would like to share with tegration cian and sends into data HealthKit to MyChart. where This through data will the then Health be App, they ally rganize uploaded data to under the Duke one Epic dashboard. EMR (Maestro D) The Care). provider places a st alerted in EPIC that for data patient is shared to upon share opening their data; patient s the chart. patient, through D. D.

13 High Touch and Accessible Care Intensive outpatient treatment Multidisciplinary care Remote monitoring Home-based care IV therapy protocols Lasix Magnesium Potassium Telephonic triage protocols Telephonic follow up scripts Emergency department triage protocol Triage and disposition workflows Nursing competency modules Consultative expertise

14 Summary and Conclusions The heart failure epidemic will force us to consider new strategies to treat this patient population Co-morbidity management is critical Increased integration of implantables and wearables Access, Access, Access