Undergraduate Health Sciences Student Research Volunteer Queen's University, Ontario, Canada
Background: Most heart function clinics cannot absorb their high volume of referrals. Effectiveness of clinic discharge protocols to offload stable patients is understudied. We aimed to examine predictors and barriers of implementing discharge criteria at our tertiary heart function clinic.
METHODS AND RESULTS: We developed a two-level discharge criteria; Tier I: for patients who recovered their ejection fraction and have no significant residual disease, tier II patients with residual disease that requires a cardiologist follow-up (see figure 1). We then reviewed the implementation between August 1st, 2023, and March May 31st, 2024, extracting patient- and provider-related characteristics at initial and most recent visits. The primary outcome was successful discharge (defined as actual discharge of patients who met tier I or II criteria ). Out of 153 patients, 92 were suitable for discharge, however, only 56/92 (60.9%) were discharged. (Table 1) Failure to discharge was associated with atrial fibrillation (30.4% of discharged patients vs 66.7% of not-discharged patients; p< 0.001), having ejection fraction ≥50% at the last visit (48.2% vs 22.2%; p=0.012), better kidney function at initial and final visit (p=0.036, p=0.048), and lower # of telephone visits for HF (p < 0.001), and lower duration of follow-up (p < 0.001). Upon thematic analysis, the two most common reasons cited for failure to discharge were providers waiting an extra left ventricular function assessment (48.6%) or coordinating with other cardiac care teams like electrophysiology (45.9%).
Conclusion: Successful discharge rate from our clinic is suboptimal which impedes timely care for new referrals. We identified several patient- and provider-specific barriers to successful discharge. More studies are needed to explore this important area.
