Abstract 4366502: Graduation from a Nurse Practitioner-led, Team-Based Cardiovascular-Kidney-Metabolic Clinic Improves Cardiovascular-Kidney-Metabolic Health and is Associated with Hospitalization Reduction: Initial Experience in an Academic Community Practice

Abstract

Background: Cardiovascular-Kidney-Metabolic (CKM) syndrome, defined as the interplay of metabolic and kidney disease on cardiovascular conditions, is widely prevalent. Novel drug classes improve outcomes in patients with CKM syndrome yet remain underused. Question: Does a nurse practitioner-led, team-based Cardiovascular-Kidney-Metabolic clinic improve health, utilization of CKM therapies, and clinical outcomes? Methods: We established a nurse practitioner-led CKM clinic in March 2023 to provide coordinated multidisciplinary care with a CKM care team, including referrals to obesity management, a dietician, an exercise program, sleep medicine, and hepatology. We measured laboratory parameters and medication intensity pre- and post-graduation. Results: A total of 320 patients enrolled, of which 86 patients disenrolled, 168 remain in program, and 66 have graduated. At the time of enrollment, the mean age of graduates was 62.4 ± 12.0 years, 42% were women, and 24% had diabetes, coronary artery disease, and heart failure. For the patients evaluated, mean BMI decreased from 40.7 ± 9.8 kg/m2 to 37.7 ± 9.1 kg/m2 (p<0.0001), HbA1c decreased from 7.1 ± 1.5% to 6.3 ± 0.9% (p<0.0001), systolic blood pressure decreased from 122.0 ± 14.5 mmHg to 117.3 ± 14.2 mmHg (p < 0.005), LDL cholesterol decreased from 79.9 ± 37.3 mg/dl to 65.4 ± 26.3 mg/dl (p<0.0001), triglycerides decreased from 177.5 ± 190.0 mg/dl to 138.1 ± 83.8 mg/dl (p<0.001). From enrollment to graduation, GLP-1 RA use increased from 18% to 89% and SGLT2i use from 37% to 62%. Mean time in program was 315±145 days with an average of 4.8 visits with the nurse practitioner. Nearly half (44%) of patients received a pharmacist consultation. A mean of 2.3 referrals to ancillary services were made per patient. In the 365 days prior to enrollment, 64 hospitalizations occurred in the cohort; during the mean time in program of 315 days, there were 19 hospitalizations (p<0.0001), which represents an annualized reduction in hospitalizations of 65.6%. Conclusion: Early experience shows the efficacy of nurse practitioner-led CKM care team in improving cardiometabolic health and reducing hospitalizations. Clinical Implications: Care gaps in delivering comprehensive CKM care to high-risk cardiac patients are prevalent. Operationalizing a model of care to address these gaps can be challenging. The nurse practitioner-led team-based model presented here serves as a replicable, clinically effective, and resource-effective model.