Multicenter randomized trial of a comprehensive hospital discharge and outpatient heart failure management program

Abstract

Aims: Disease management programs can reduce hospitalizations in high-risk heart failure (HF) patients, but generalizability to the population hospitalized for HF remains to be proven. We aimed to assess the effectiveness of a discharge and outpatient management program in a non-selected cohort of patients hospitalized for HF. Methods and results: Patients admitted with decompensated HF were randomized to receive usual care (n = 174) or an intervention (n = 164) consisting of a comprehensive hospital discharge planning and close follow-up at a HF clinic. After a median of 509 days, there were fewer events (readmission or death) in the intervention as compared with the control group (156 vs. 250), which represents 47% (95%CI: 29 -65; P < 0.001) event reduction per observation year. At 1-year, time to first event, time to first all-cause and HF readmission, and time to death were increased in the intervention group ( P < 0.001). All-cause and HF readmission rates per observation year were significantly lower, quality of life improved and overall cost of care was reduced in the intervention group. Conclusions: This comprehensive hospital discharge and outpatient management program prolonged time to first event, reduced hospital readmissions, improved survival and quality of life of patients hospitalized for HF, while reducing cost of management.

Transitional Care Interventions Prevent Hospital Readmissions For Adults With Chronic Illnesses

“…The trials were conducted in a broad variety of international health care systems. Eleven were from the United States; [26][27][28][29][30][31][32][33][34][35][36] three from Hong Kong; [37][38][39] two from Australia; 40,41 and one each from Germany, 42 Spain, 43 Canada, 44 Sweden, 45 the United Kingdom, 46 Ireland, 47 Italy, 48 China, 49 Taiwan, 50 and a collaboration between Spain and Belgium. 51 The studies' sample sizes ranged from 41 to 1,001 people.…”

“…Second, most 27,29,30,32,[34][35][36][37][38][39]42,43,45,[47][48][49]51 of the transitional care interventions that showed an effect on intermediate-and long-term readmissions lasted longer than thirty days and measured the intermediate-and long-term rates of readmission only after thirty days. These interventions could also have had an effect within the first thirty days, but this was not measured.…”

Proceso de alta hospitalaria, revisión de la literatura

“…Otra intervención en pacientes con insuficiencia cardiaca consistente en una planificación del alta y un estrecho seguimiento ambulatorio, demostró ser útil en reducir los reingresos y muertes a 500 días (p < 0,001), y en prolongar el tiempo hasta la primera recaída, reingreso o muerte (p < 0,001) 92 . El proyecto RED que consistió en un plan de alta desarrollado por una enfermera (que agenda los controles al alta, confirma la CIM, educa al paciente con folletos), y por un farmacéutico clínico (que llama por teléfono a los pacientes a los 2 y 4 días post alta), resultó en una reducción en la utilización de los hospitales (p = 0,009), siendo más eficaz en pacientes con estadías hospitalarias dentro de los 6 meses previos al ingreso (p = 0,01) 93 .…”

Impact of heart failure clinic visit frequency on hospital admission rates

“…The frequency of visits ranged from four to 19 visits over the threeyear period and averaged one every 4.5 months. A wider range in terms of visit frequency has been reported, with visits ranging from twice weekly (21), weekly/biweekly (22)(23)(24), monthly/bimonthly (18,25,26), every three to four months (27,28), as well as one to two total visits (29)(30)(31), and 'individual' or 'as needed' (16,(32)(33)(34).…”