P159 - INDIVIDUAL VS POOLED FOLLOW-UP IN A MULTIDISCIPLINARY HEART FAILURE CLINIC

Background: Multidisciplinary heart failure (HF) clinics employ varying follow-up models regarding cardiologists' approach. In an "individual" model, each patient is assigned to a given cardiologist, implying that in-person visits with the heart failure team are scheduled according to the physician’s availability. In contrast, the "pooled" model allows patients to be managed by any available cardiologist at each visit. At the CHU de Québec – Université Laval, both models are used across two multidisciplinary clinic sites, with the same group of cardiologists rotating through both. While the pooled model may offer logistical advantages, concerns have been raised about trajectory of care and potential inefficiencies due to unfamiliarity with patient’s medical history and weaker therapeutic relationship.

METHODS AND RESULTS:

Objective:
To compare the effectiveness, assessed by the total duration of follow-up, of individual versus pooled follow-up models in a multidisciplinary HF clinic setting.

Methods:
We conducted a retrospective cohort study including 200 adult patients with HF who completed their follow-up at the clinic between 2019 and 2023 (100 per group, with balanced representation of preserved and reduced left ventricular ejection fraction). Patients were categorized based on follow-up model: 1) individual, 2) pooled. Data were extracted from the electronic medical records.
The primary outcome was the total duration of follow-up in the HF clinic, used as a surrogate for care efficiency—shorter duration indicating more efficient resource use.
Secondary and safety outcomes included time to maximally tolerated HF therapy, all-cause mortality, hospitalizations and re-enrollment to the program.

Results:
The median duration of follow up was 476 days for the individual follow-up VS 309 days for the pooled follow-up (p = 0.17). The median time to maximally tolerated therapy was also comparable between groups: 193 days VS 190 days (p = 0.48), respectively. There were no statistically significant differences in safety outcomes. All-cause mortality occurred in 16 patients in the individual group VS 20 in the pooled group (p = 0.51). All-cause hospitalizations were reported in 85 VS 111 patients (p = 0.07) respectively, and cardiac-related hospitalizations in 32 VS 44 patients (p = 0.17), respectively. Re-enrollment within 11 months occurred in 3 patients in the individual group VS 8 in the pooled group (p = 0.13).

Conclusion: In a multidisciplinary HF clinic setting, pooled follow-up was as efficient and may be as safe as individual follow-up by a dedicated cardiologist. These findings support the use of a pooled care model without compromising patient outcome or resource utilization.