ACC Quality Summit Posters Look at COVID-19 Impact on HF; EHR For Cardiogenic Shock; GLP1-RA, SGLT2 Inhibitor Use

Award-winning posters presented at ACC Quality Summit Virtual, Sept. 29 – Oct. 1, highlights the impact of COVID-19 on heart failure (HF) patients; management of cardiogenic shock through an alert system within an electronic health record (EHR); and increasing use of GLP1-RAs and SGLT2 inhibitors among patients with diabetes.

For the first-place poster, Kyle A. Ulversoy, BA, and Jonathan Murrow, MD, FACC, looked at the effect of the COVID-19 pandemic on cost and readmission rates among HF patients at Piedmont Athens Regional Hospital in Georgia and found no significant difference in costs or outcomes in HF patients before and after the pandemic at the facility. A cohort of 100 patients with a primary diagnosis of HF from 2019 and 2020 were randomly selected, and costs were estimated using length of stay. The cohort was separated into two time periods – those admitted pre-pandemic, before March 11, 2020, and those during the pandemic. The study showed an average length of stay, or cost, of 4.86 days and $32,578 pre-pandemic vs. 5.77 days and $38,664 during the pandemic. Readmission rates were 0.175 and 0.209 pre-pandemic vs. during the pandemic. However, a subcohort of Black patients had a longer length of stay during the pandemic (6.79 days vs. 4.41 days), which confirmed that Black populations experienced high morbidity related to cardiovascular disease during the pandemic.

Krithika Krishnarao, DO, at Mayo Clinic Jacksonville in Florida received the second-place poster award for creating an EHR-based alert system aimed at addressing primary factors contributing to deaths related to cardiogenic shock – late identification, inefficient multidisciplinary communication and nonstandardized management. A "Stage, Page, Engage" system was created within the EHR to identify and risk-stratify patients at risk of cardiogenic shock, alert appropriate members of the multidisciplinary cardiovascular team, and engage a cardiovascular-thoracic-transplant intensive care unit to treat patients. The system was tested in a historical cohort of 529 patients and an optimization cohort of 187 patients at higher risk for cardiogenic shock who were continuously stratified by EHR scoring. In-hospital mortality among patients requiring mechanical circulatory support decreased from 64% in the historical cohort to 21% in the optimization cohort. The study concluded that the EHR-based system could effectively risk-stratify patients with cardiogenic shock at risk of mortality and "potentially improve outcomes and reduce overall spending in this high-risk group."

For the third-place award, Nina Mirachi, PA-C, MBA, et al., of Cardiology Consultants of Philadelphia in Pennsylvania developed a program led by advanced practice providers (APPs) to increase use of GLP1-RAs and SGLT2 inhibitors among patients with diabetes. Patients were referred to the program via an EHR program and were then scheduled for a telemedicine visit with an APP to discuss cardiovascular risk reduction and diabetes. If indicated, the APP recommended a GLP1-RA and SGLT2 inhibitor was prescribed, which was them prescribed by the cardiology APP or primary care physician/endocrinologist. Patients were closely monitored for adverse effects. Between January and June 2021, 27 patients were referred to the program, 21 of whom were identified as good candidates for the medications. Of these patients, nine have successfully initiated a GLP1-RA or SGLT2 inhibitor and another nine are being evaluated for treatment. The study concluded that APPs with knowledge of diabetes and cardiovascular risk reduction "can push the needle" to increase use of GLP1-RAs and SGLT2 inhibitors and actively work with other providers to initiate the medications when indicated.

In addition, three posters submitted to Quality Summit received Honorable Mentions:

  • High-Sensitive Troponin-I Assay Implementation and Impact on Emergency Department Throughput
    Kathryn Jaramillo, MS, RN, CNS-BC, AACC, and Shuwen Chen, PhD
    El Camino Health, Mountain View, CA
  • Improving Multicampus Documentation of Risk Stratification Scores For NSTEMI Population in the Chest Pain-MI Registry
    Esther Gacugi, MBA, PMP

    Baylor Scott & White The Heart Hospital, Plano, TX
  • STEMI Door-to-Balloon Time: Back to Basics
    Cristina Chonko, AGPCNP-BC
    and Linette Abreu, MHA, RN-DBA
    Bayshore Medical Center/HMH, Holmdel, NJ

Clinical Topics: COVID-19 Hub, Heart Failure and Cardiomyopathies, Acute Heart Failure, Cardiovascular Care Team

Keywords: Quality Summit, COVID-19, SARS-CoV-2, Patient Care, Care Team, National Cardiovascular Data Registries, Chest Pain MI Registry, Sodium-Glucose Transporter 2 Inhibitors, Cardiovascular Diseases, Pandemics, Hospital Mortality, Endocrinologists, Shock, Cardiogenic, Physicians, Primary Care, African Americans, Length of Stay, Patient Readmission, Risk Factors, Diabetes Mellitus, Intensive Care Units, Morbidity, Telemedicine

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