ACCF/AHA/HFSA 2011 Survey Results: Current Staffing Profile of Heart Failure Programs, Including Programs that Perform Heart Transplant and Mechanical Circulatory Support Device Implantation

Study Questions:

What is the current staffing utilization of heart failure (HF), transplant, and/or mechanical circulatory support programs in the United States and abroad?

Methods:

A 50-item online survey (live for 2 months in 2009) sponsored by the American College of Cardiology Foundation, American Heart Association, and Heart Failure Society of America was sent to members of the aforementioned organizations who identified themselves as interested in HF, transplant, or both. For sites with >1 staff member response, answers were averaged. Results were analyzed with regard to practice size (small program [<4 staff], small-medium program [4-10 staff], medium program [11-20 staff], large program [>20 staff]) and number of transplants performed per year.

Results:

There were 1,823 survey invitations sent via email with an individual response rate of 23%, representing 257 unique practices in the United States (81%) and abroad (19%). Respondents included physicians (67%), nurse practitioners (20%), and nurses (3%). Most practices were categorized as having affiliations with medical schools (31%), cardiovascular groups (28%), government hospitals (14%), and nongovernment hospitals (18%). Most practices were small (43%) or medium (34%) in size; only 6% were identified as large programs. The average HF program cared for 1,641 outpatients, and the average transplant program performed 10 transplants yearly. On average, programs had 2.7 physician full-time equivalents (FTEs), 2.2 nurse practitioners/physician assistant FTEs, and 2.6 nurse coordinator FTEs. While larger programs cared for more transplant and HF patients, 500-700 additional annual HF visits were required prior to a doubling of staffing.

Conclusions:

With the increase in HF prevalence, staffing guidelines should be developed to ensure that an adequate number of qualified individuals are hired for a given HF-transplant practice volume.

Perspective:

The growing prevalence of HF and the fiscal burden of recurrent HF readmissions have led to increased scrutiny placed on physicians providing HF care. Recently, ‘pay for performance’ measures have been adopted by many agencies and third party payers in an effort to reduce HF costs through perceived improvements in evidence-based care.

Limitations of a population survey aside, this study highlights the ‘gerbil on a wheel’ feeling many HF physicians face when caring for these complex patients. HF patient volumes are vast and the number of clinicians trained in Advanced Heart Failure and Cardiac Transplant care annually is scant. Both the number of Advance Heart Failure fellowships and the number of individuals interested in entering this field are few because incentives are low. In the past 5 years, few interventions have been shown scientifically to substantially improve HF outcomes, and the number one cause for readmission in many studies is patient nonadherence. Unfortunately, studies on complex patient telemanagement programs meant to improve patient adherence and reduce readmissions have been inconsistent in demonstrating benefit.

HF is only going to increase in burden. Studies are needed to identify the best and most cost-effective means of providing long-term management for these patients. Finally, incentives to attract practitioners into the field of advanced HF are warranted.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant

Keywords: Prevalence, Cardiology, Nurse Practitioners, Heart Failure, Schools, Medical, Physician Assistants, United States, Heart Transplantation


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