SUPPORTIVE CARDIOLOGY: A QUALITY IMPROVEMENT PROJECT TO MEET THE GAPS IN LATE-STAGE HEART FAILURE CARE

Embedding a palliative approach into advanced heart failure management remains an important yet challenging aspect of the current care model. The aim of this project was to explore the gaps in the patient journey, identify opportunities for improvement, and empower patients, their supporters, and clinicians.

Through a Quadruple Aim health systems performance framework, patients with end-stage heart failure were interviewed regarding their healthcare journey. It is essential to highlight the frailty of this patient population, with the majority of interviewees not surviving to completion of the initiative. Responses were thus transcribed and themes extracted by multidisciplinary stakeholders. Two novel, in-house designed interactive tools were created from the provider and patient perspective. Five Continuing Medical Education (CME) events were held for primary care and specialist providers for heart failure patients, with attendees surveyed on their understanding of palliative cardiology. N=16 stakeholders extracted themes from 10 patient interviews. Access to primary care providers was a noted positive experience (100%, n=16). System navigation (38%, n=6), information sharing (38%, n=6), and a lack of understanding (25%, n=4) were challenges identified. Creation of the two educational tools was informed by this described patient experience; they have been created as mirror tools for the purpose of empowering patients and supporting clinician skill set development in caring for this population. Currently, the tools are being implemented in local general practice clinics, and provided to patients referred to our center’s Heart Function clinic. With regards to the CME events, as many as 100% of survey respondents reported improved skills (n=53); free-text responses noted increased motivation in pursuing palliative approaches.

The Supportive Cardiology project identified gaps in the care of end-stage heart failure patients, particularly with respect to navigating the diagnosis, the illness trajectory and the healthcare system itself. Two novel, educational tools have been created to address these gaps. Acknowledging the frailty and mortality of this population, this initiative has allowed for the opportunity to understand the patient experience in advanced heart failure. CME events improve provider capabilities in approaching end-stage heart failure care. Next steps include spread of the tools with the ultimate goal being establishment of a sustainable, educational, widespread source of information with regards to palliative approaches in advanced heart failure care.