Table 2

Treatment optimisation and other interventions at multispecialty MDT meeting

ConditionMedicines optimisationPremultispecialty MDTPostmultispecialty MDTP value
Heart failure1. Quadruple therapy in HFrEF65/141 patients (46%)101/141 patients (71%)<0.001
2. ICD12 patients14 patientsNS
3. CRT+-D13 patients14 patientsNS
4. Advanced HF referral5 patients6 patientsNS
CKD1.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 therapy2 patients13
patients
Type 2 diabetes1. 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. Falls1. 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. Bleeding2. 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 stateReduction 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 infectionStopping H2 antagonist of proton pump inhibitor in absence of clear indication (proven peptic ulcer, gastrointestinal bleeding or dyspepsia (41 patients)
Optimising management of chest conditions1. Referral for spirometry and optimising inhalers9/103 (9%)38/103 (37%)<0.001
2. Pleural effusion drain2 patients9 patientsNA
3. New diagnosis of sleep apnoea6 patients17 patientsNA
Referral to community falls assessment clinic7 patients23 patientsNA
Advanced care planning and palliationNon-essential medications stopped12 patients37 patientsNA
AnaemiaStopping oral iron, administration of intravenous iron, erythropoietin, folic acid or vitamin B12Persisting 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.