Better Workflows Bolster LVAD Care & Cardiac Rehab Referrals

Photo Credit: myboxpra

Research presented at ACC.25 focused on coordination teams and new hospital workflows designed to improve referrals and care quality for cardiology patients.

Improved care coordination for patients with cardiac needs was among the major topics presented at ACC.25.

Improved Care for LVAD Readmissions

A new hospital workflow improved clinician burden and care quality for patients readmitted for left ventricular assist devices (LVADs).¹

Before the study, patients readmitted for LVADs were universally assigned to a heart failure cardiologist, without consideration for presenting diagnoses—and more than half of readmissions turned out to be non-cardiac in nature.

“This congested the cardiac LVAD cardiologist census and often resulted in cardiologists directing care for non-cardiac diagnoses,” wrote Laura K. Ogle, NP, and Timothy VanVoorhis, PA.

By contrast, the co-management model incorporated heart failure cardiologists, hospitalists, and heart failure advanced practice providers (APPs). The clinicians developed a streamlined process for assigning readmitted patients to either a cardiologist or hospitalist, depending on their admitting diagnoses.

Five hospitalists underwent an LVAD bootcamp to learn the basics of LVAD care. Patients assigned to a hospitalist also saw an APP with more thorough knowledge of LVAD and heart failure. A heart failure cardiologist was available for consultations if needed.

Using a post-implementation survey to examine the program’s effectiveness, the researchers determined that the co-management model ensured that clinicians were able to meet patients’ individual care needs. Patients received comprehensive care throughout their admissions, and clinicians reported improved satisfaction.

“This improved process allowed the cardiac LVAD team time to see patients in the outpatient LVAD clinic and ICU allowing for better utilization of resources,” the researchers concluded. “Clinical outcomes remained consistent throughout the implementation of this reimagined workflow.”

Team Boosts Cardiac Rehab Referrals

A recent quality improvement project helped bolster referrals to outpatient cardiac rehabilitation for patients with acute coronary syndromes.²

“Cardiac rehabilitation has been associated with reduced mortality, hospital admissions, and increased health-related quality of life,” wrote Courtney Falconer, A-GNP, and colleagues. “However, referral to cardiac rehabilitation remains suboptimal.”

The researchers therefore examined the utility of having a dedicated cardiac rehabilitation coordination team at their tertiary hospital. They compared the number of referrals for patients admitted in 2022 and 2023, the year the team was implemented.

The following three strategies were tested:

1. The coordination team supplied complete referral documentation to the cardiac rehabilitation center.
2. The team sent basic referrals and involved the outpatient cardiology offices.
3. The number of staff for the coordination team was increased.

The analysis showed cardiac rehabilitation referrals went up by 73.6%, from 20% (22 of 110) pre-implementation to 93.6% (88 of 94) post-implementation (P<0.001).

With a referral success rate of 29.9% (72 of 241), the least effective strategy was to send all documentation. Outsourcing record-gathering to the outpatient offices and increasing the number of coordination team staff proved more effective, with referral rates of 59.1% (75 of 127) and 58.8% (50 of 85), respectively (P<0.001).

“Significant improvements in cardiac rehabilitation referrals are noted when outpatient providers’ offices are directly involved in the referral process,” the researchers concluded. “Cardiac rehab coordination teams play a crucial role in improving communication and arranging cardiac rehabilitation referrals.”