Condition | Medicines optimisation | Premultispecialty MDT | Postmultispecialty MDT | P value |
Heart failure | 1. Quadruple therapy in HFrEF | 65/141 patients (46%) | 101/141 patients (71%) | <0.001 |
2. ICD | 12 patients | 14 patients | NS | |
3. CRT+-D | 13 patients | 14 patients | NS | |
4. Advanced HF referral | 5 patients | 6 patients | NS | |
CKD | 1.Initiation of ACEi/ARB in patients with HFrEF and CKD4 (up to eGFR 20 mL/min/1.73 m2) | 4/45 (9%) | 32/45 (71%) | <0.001 |
2.Potassium binder therapy for hyperkalaemia due to RAASi therapy | 2 patients | 13 patients | ||
Type 2 diabetes | 1. Stopping or reducing dose of sulphonylureas and starting SGLT2i (42 patients) | HbA1c control | ||
68±11 (mmol/mol) | 61±9 (mmol/mol) | <0.001 | ||
2. Switching from DPP4 inhibitor to SGLT2i (33 patients) | ||||
3. Adding SGLT2i to Insulin (19 patients) | ||||
Adverse drug reactions | ||||
1. Falls | 1. Reduction in anticholinergic burden by deprescribing medications such as anti-histamines (17 patients), Nitrate substituted for Ivabradine or ranolazine (6 patients) | ACB 1.85±0.4 | 1.5±0.3 | <0.001 |
Hospital admissions | ||||
41/334 (12%) | 18/334 (5%) | 0.003 | ||
2. Bleeding | 2. Switching from dual-antiplatelet to single-anti-platelet therapy or stopping anti-platelet when used in combination with anticoagulant (17 patients) | |||
3. Delirium/acute confusional state | Reduction in or stopping antimuscarinic drugs such as Oxybutynin (9 patients), anti-histamine (17 patients), opioid analgesia (21 patients), sedative drugs (9 patients) and antispasmodics | |||
4. Reduction in risk of C.difficile infection | Stopping H2 antagonist of proton pump inhibitor in absence of clear indication (proven peptic ulcer, gastrointestinal bleeding or dyspepsia (41 patients) | |||
Optimising management of chest conditions | 1. Referral for spirometry and optimising inhalers | 9/103 (9%) | 38/103 (37%) | <0.001 |
2. Pleural effusion drain | 2 patients | 9 patients | NA | |
3. New diagnosis of sleep apnoea | 6 patients | 17 patients | NA | |
Referral to community falls assessment clinic | 7 patients | 23 patients | NA | |
Advanced care planning and palliation | Non-essential medications stopped | 12 patients | 37 patients | NA |
Anaemia | Stopping oral iron, administration of intravenous iron, erythropoietin, folic acid or vitamin B12 | Persisting anaemia 81/334 (24%) | 18/334 (5%) | <0.001 |
ACB, anticholinergic burden; ARB, angiotensin receptor blocker; CRT, cardiac resynchronisation therapy; CRT, cardiac resynchronisation therapy; HFrEF, heart failure with reduced ejection fraction; ICD, internal cardiovertor-defibrillator; MDT, multidisciplinary team; RAASi, renin-angiotensin-aldosterone system inhibitor; SGLT2i, sodium-glucose co-transporter2 inhibitor.