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

IF 2.8 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Open Heart Pub Date : 2025-08-31 DOI:10.1136/openhrt-2025-003496

Yoshiharu Kinugasa, Kensuke Nakamura, Masayuki Hirai, Midori Manba, Natsuko Ishiga, Takeshi Sota, Natsuko Nakayama, Tomoki Ota, Masahiko Kato, Masaru Kato

{"title":"MAGGIC risk score-based risk stratification for selecting patients with heart failure who will benefit from multidisciplinary care.","authors":"Yoshiharu Kinugasa, Kensuke Nakamura, Masayuki Hirai, Midori Manba, Natsuko Ishiga, Takeshi Sota, Natsuko Nakayama, Tomoki Ota, Masahiko Kato, Masaru Kato","doi":"10.1136/openhrt-2025-003496","DOIUrl":null,"url":null,"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.","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406894/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open Heart","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/openhrt-2025-003496","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

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.

Abstract Image

查看原文本刊更多论文

基于MAGGIC风险评分的心衰患者风险分层选择将受益于多学科治疗的患者。

目的：世界范围内的指南推荐由多学科团队组成的专科门诊来管理心力衰竭（HF）患者。然而，关于如何最好地选择这些患者以有效利用资源的信息有限。本研究旨在根据干预时间和患者风险分层确定心衰患者出院后团队护理的有效性。方法：我们回顾性地确定了2021年1月至2023年6月期间在我们机构因急性失代偿性心衰住院的185例符合条件的患者。多学科团队护理被定义为出院后心脏病专家和护士的门诊随访。主要结局是心血管相关死亡和1年内HF再入院的综合结果，比较接受HF团队护理的患者和接受标准随访的患者。结果：有53.0%的HF患者接受了团队护理，这些患者比接受标准随访的患者年龄小，需要更多的口服肌力药物、托伐普坦和胺碘酮。在接受心衰团队护理的患者中，大多数（58.2%）在出院后的干预时间不超过30天。在通过治疗加权逆概率调整背景差异后，心衰团队护理与180天的有利结果相关，但1年的主要结果在组间无显著差异。在亚组分析中，慢性心力衰竭Meta-Analysis Global组评分较高的患者（≥28），表明心衰加重的风险较高，心衰团队护理的1年事件发生率显著降低（相互作用的p值）。结论：多学科心衰团队护理对心衰加重高风险患者最有效。风险评分模型可以优化患者选择专科护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Open Heart CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.60

自引率

3.70%

发文量

145

审稿时长

20 weeks

期刊介绍： Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.