(P154) BARRIERS OF SUCCESSFUL IMPLEMENTATION OF DISCHARGE CRITERIA AT A TERTIARY HEART FUNCTION CLINIC

Background: Most multidisciplinary heart function (HF) clinics cannot absorb the high volume of referrals they receive. We developed and implemented an HF clinic discharge protocol based on guideline recommendations and clinical experience (see Figure 1). This study aims to examine the predictors and barriers of successfully implementing the discharge criteria at our tertiary HF clinic.

METHODS AND RESULTS: We reviewed patients with >=3 visits to our HF clinic between Aug 1st, 2023, and March 31st, 2024. We extracted patient-related and provider-related characteristics at initial and most recent clinic visits. The clinicʼs established discharge algorithm (Figure 1), was used to categorize patient eligibility for discharge. The primary outcome was rate of successful discharge (defined as actual discharge of patients deemed suitable for discharge according to the protocol).

Of 169 patients reviewed (mean age 71+/- 13 yrs, 64.5% men, and 9% HFpEF), 71 patients (42.5%) were deemed suitable for discharge, however, only 27/71 (38.03%) were actually discharged. Failure to discharge was associated with atrial fibrillation ((AF); 21.7% of discharged patients had AF vs 67.6% of patients who were not discharged; p-value < 0.001), having had a HF hospitalization within 12 months (37% vs 62.8%; p-value = 0.036), and having moderate/worse valvular heart disease ((VHD); 40% of discharged patients had VHD vs 65.7% of patients who were not discharged; p-value 0.048), and having an ejection fraction (EF) of less than 50% at the time of second visit (33.3% of discharged patients vs 80% of not discharged patients, p-value=0.017). As for HF providers' characteristics, early-to-mid career status (defined as < 10 years in practice) was associated with lower rate of successful discharge (13% of discharged patients vs 55.5% patients who were not discharged had an HF provider with < 10 years clinical experience; p-value = 0.001). To investigate reasons for failure to discharge, thematic analysis revealed that desire to repeat echocardiograms (1 more time) to confirm improvement of left ventricular (LV) function (20/49, 40.8%), and coordinating care with other cardiac care teams (arrhythmia, surgery, structural heart team; 14/49, 28.6%) to be most cited barriers for discharge of patients who otherwise met criteria for discharge.

Conclusion: The rate of successful discharge of stable patients at our HF clinic is suboptimal (38%) which impedes timely care for new referrals. We identified several patient-related characteristics and provider-specific barriers for successful discharge which are prime targets for quality improvement initiative. More studies are needed to explore this important area.