Abstract 4360903: Impact of Early Cardiology Consultation on In-Hospital Outcomes in Heart Failure.

Background: Acute decompensated heart failure (ADHF) is a medical emergency associated with high morbidity and mortality. Specialist cardiology consultation (CC) has been linked to improved short- and long-term outcomes in heart failure. However, there is a paucity of data on the effect of CC timing during hospitalization. Methods: We u tilized North Texas Healthcare Database (2018–2024) to identify ADHF hospitalization in adults aged >18 years. CC were identified using relevant ICD-10-CM codes. CC timing was categorized by day 1 (D1), day 2 (D2), and day 3 (D3) from admission. Primary outcomes included hospital length of stay (LOS), ICU LOS, mechanical ventilation (MV), 90-day readmission, and all-cause mortality (ACM) using multivaraible regression analysis. Result: Of 22,294 encounters; 17,105 (76.7%) received a D1 consult, 3,697 (16.6%) D2, and 1,488 (6.7%) D3. Patients aged >80 years were more represented in D2 and D3 cohorts (26.96% vs. 29.27% vs. 28.83%). Racial distribution was comparable across groups. Males were more prevalent in D1 (54.83%) than D2 (51.18%) and D3 (50.67%). Among comorbidities, smoking (38.24%) and diabetes (57.73%) were most common in D3, while coronary artery disease was highest in D1 (66.27%). Reduced ejection fraction (EF) was more frequent in D1 (59.77%), while preserved EF was more common in D3 (43.75%). Use of beta-blockers (86.52%) and diuretics (79.40%) peaked in the D1 cohort. Median BNP was highest in D1 (1036.6 vs. 1022.8 vs. 965.8; p<0.05). Mean BMI (32.75) and Elixhauser Comorbidity Index (2.01) were highest in D3. Multivariable regression showed that D3 consults were associated with higher odds of prolonged hospital LOS (aOR 1.46) and ICU LOS (aOR 1.21). D2 consults were associated with lower ICU LOS (aOR 0.97) and significantly reduced odds of MV (aOR 0.74). Although D3 consults showed increased odds for ventilation (aOR 1.24),not statistically significant. No significant differences were observed in 30-day readmission or ACM across groups. Conclusion: Early CC, particularly on D1, was associated with shorter hospital and ICU stays, reduced need for mechanical ventilation, and increased use of guideline-directed therapies. Delays beyond day 2 correlated with longer stays and greater ICU burden. While mortality and readmission rates were similar, later consults may increase hospital costs and resource utilization. Timely cardiology involvement may improve outcomes and optimize healthcare efficiency in ADHF management.