MAGGIC risk score-based risk stratification for selecting patients with heart failure who will benefit from multidisciplinary care

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Abstract
Objective: Guidelines worldwide recommend specialist outpatient clinics staffed by a multidisciplinary team for management of patients with heart failure (HF). However, there is limited information on how best to select these patients for efficient use of resources. This study aimed to determine the effectiveness of team-based care for patients with HF after discharge from hospital according to duration of intervention and stratification of patients according to risk. Methods: We retrospectively identified 185 eligible patients who were hospitalised with acute decompensated HF at our institution between January 2021 and June 2023. Multidisciplinary team care was defined as outpatient follow-up by both cardiologists and nurses postdischarge. The primary outcome was a composite of cardiovascular-related death and readmission with HF within 1 year, which was compared between patients receiving HF team care and those receiving standard follow-up. Results: HF team care was provided for 53.0% of patients, who were younger than those receiving standard follow-up and required more oral inotropes, tolvaptan and amiodarone. Among those receiving HF team care, the majority (58.2%) had an intervention duration of 30 days or less after discharge. After adjusting for background differences by inverse probability of treatment weighting, HF team care was associated with favourable 180-day outcomes, but there was no significant between-group difference in the 1-year primary outcomes. In subgroup analysis, patients with a higher Meta-Analysis Global Group in Chronic Heart Failure score (≥28), indicating a higher risk of exacerbation of HF, had significantly lower 1-year event rates with HF team care (p value for interaction <0.05). Conclusions: Multidisciplinary HF team care is most effective for patients at higher risk of exacerbation of HF. A risk score model may optimise patient selection for specialised care.
Funding Information
  • JSPS KAKENHI (20K08403)

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