Protocol-based follow-up program for heart failure patients: Impact on prognosis and quality of life

Agostinho, João R.; Gonçalves, Inês; Rigueira, J; Aguiar-Ricardo, I; Nunes-Ferreira, A; Santos, R; Guimarães, Tatiana; Alves, Pedro Nascimento; Cunha, Nelson; Rodrigues, Tiago; André, ŃZinga; Pedro, Maria Isabel; Veiga, Francisco José; Pinto, Fausto J.; Brito, Dulce

doi:10.1016/j.repc.2019.03.006

Cited by 15 publications

(18 citation statements)

References 33 publications

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“…A recent study showed that telephone contact with patients within 48 h of discharge lowered early readmission rates compared with those who had no contact (9.2% versus 15.7%, p = 0.011) [18]. Further research is therefore needed, focussing on safe discharge [19] and follow-up care for patients [20][21][22] and effective communication with primary care physicians [23]. The uncoupling of mortality rates between frequency of readmissions narrowed in the oldest age group may be due to higher rates of mortality or palliation in the community among this group which prevent them from readmissions.…”

Section: Discussionmentioning

confidence: 99%

Early emergency readmission frequency as an indicator of short-, medium- and long-term mortality post-discharge from hospital

et al. 2020

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Frequent emergency readmissions, an indicator of quality of care, has been rising in England but the underlying reasons remain unclear. We examined the association of early readmissions with subsequent mortality in adults, taking into account the underlying presenting diagnoses and hospital length of stay (LOS). Data of alive-discharge episodes were prospectively collected between 01/04/2017 and 31/03/2019 in an National Health Service hospital, comprising 32,270 patients (46.1% men) aged 18–107 years (mean = 64.0, ± SD = 20.5 years). The associations of readmission frequency within 28 days of discharge and mortality within 30 days and 6 months of hospital discharge, and over a 2-year period were evaluated, adjusted for presenting diagnoses, LOS, age and sex during the first admission. Analysis of all patients 18–107 years (reference: no readmission) showed mortality within 30 days was increased for 1 readmission: event rate = 9.2%, odds ratio (OR) = 3.4 (95% confidence interval (CI) = 2.9–4.0), and ≥ 2 readmissions: event rate = 10.0%, OR = 2.6 (95%CI = 2.0–3.3), and within 6 months for 1 readmission: event rate = 19.6%, OR = 3.0 (95%CI = 2.7–3.4), and ≥ 2 readmissions: event rate = 27.4%, OR = 3.4 (95%CI = 2.9–4.0), and over a 2-year period for 1 readmission: event rate = 25.5%, hazard ratio = 2.2 (95%CI = 2.0–2.4), and ≥ 2 readmissions: event rate = 36.1%, hazard ratio = 2.5 (95%CI = 2.2–2.8). Within the age groups 18–49, 50–59, 60–69, 70–79 and ≥ 80 years, readmissions were also associated with increased risk of mortality within 3 months and 6 months of discharge, and over 2-year period. In conclusion, early hospital readmission predicts short-, medium- and long-term mortality post-discharge from hospital in adults aged 18–107 years, independent of underlying presenting conditions, LOS, age and sex. Further research focussing on safe discharge and follow-up patient care may help reduce preventable readmissions and post-discharge mortality.

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Section: Discussionmentioning

confidence: 99%

Early emergency readmission frequency as an indicator of short-, medium- and long-term mortality post-discharge from hospital

et al. 2020

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“…Heart failure (HF) affects 2% of the adult population. 1 Even though post-discharge programmes with multidisciplinary teams have proved to reduce all-cause re-hospitalizations and mortality and to be cost saving, [2][3][4] HF still contributes annually to all-cause mortality rates of 17% and to hospitalization rates of 44%. 5 Driven by the development of new technologies, telemedicine is substantially growing, 6 allowing, among other things, the provision of patients' physiological parameters to health care professionals.…”

Section: Introductionmentioning

confidence: 99%

“…Heart failure (HF) affects 2% of the adult population 1 . Even though post‐discharge programmes with multidisciplinary teams have proved to reduce all‐cause re‐hospitalizations and mortality and to be cost saving, 2–4 HF still contributes annually to all‐cause mortality rates of 17% and to hospitalization rates of 44% 5 …”

Section: Introductionmentioning

confidence: 99%

Non‐invasive telemonitoring improves outcomes in heart failure with reduced ejection fraction: a study in high‐risk patients

et al. 2020

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Aims Non-invasive telemonitoring (TM) in patients with heart failure (HF) and reduced left ventricular ejection fraction (HFrEF) may be useful in the early diagnosis of HF decompensation, allowing therapeutic optimization and avoiding re-hospitalization. We describe a TM programme in this population and evaluate its effectiveness during a 12 month period. Methods and results We conducted a single-centre study of patients discharged from hospital after decompensated HF, allocated into three groups: prospective TM programme, prospective HF protocol follow-up programme (PFP) with no TM facilities, and retrospective propensity-matched usual care (UC). TM effectiveness was assessed by all-cause hospitalizations and mortality; HF-related hospitalization (HFH), days lost to unplanned hospital admissions/death, functional capacity and quality of life (New York Heart Association, Kansas City Cardiomyopathy Questionnaire, 6 min walk test, and plasma N-terminal pro-brain natriuretic peptide) were also evaluated. A total of 125 patients were included [65.9 ± 11.9 years, 32% female, left ventricular ejection fraction 27% (21-32)]. TM was similar to PFP regarding effectiveness; TM reduced all-cause hospitalization and mortality (HR 0.27; 95% CI 0.11-0.71; P < 0.01) and HFH (HR 0.29; 95% CI 0.10-0.89; P < 0.05) as compared with UC. TM reduced the average number of days lost due to unplanned hospital admissions or all-cause death as compared with PFP (5.6 vs. 12.4 days, P < 0.05) and UC (5.6 vs. 48.8 days, P < 0.01). Impact on quality of life was similar between TM and PFP (P = 0.36). Conclusions In patients with HFrEF and recent HF hospitalization, non-invasive TM reduced 12 month all-cause hospitalization/mortality and HFH as compared with usual care. TM also reduced the number of days lost due to unplanned hospital admission/death as compared with either an optimized protocol-based follow-up programme or usual care.

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“…Para esta investigación el apoyo social se evaluó a través del instrumento "MOS de apoyo social", el cual permite clasificar el índice global de apoyo social: Índice global: bajo , medio (63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81), alto (82)(83)(84)(85)(86)(87)(88)(89)(90)(91)(92)(93)(94)(95). Apoyo emocional: bajo (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)…”

Section: Apoyo Socialunclassified

“…Autores como Agostinho et al (80) encontraron que el aumento de los reingresos en pacientes con falla cardiaca es un fuerte predictor de mortalidad, cuyo riesgo aumenta significativamente con cada hospitalización. Además, tienen un enorme impacto económico, ya que la mayoría de los costos de la insuficiencia cardíaca se deben a hospitalizaciones.…”

Section: Cubillos Et Al (unclassified

Relación entre nivel de adherencia al tratamiento y apoyo social en pacientes con falla cardiaca de enero a noviembre de 2020 en Bogotá

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Acuña²,

Hoyos³

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Introducción: La falla cardiaca es una de las causas de hospitalización más frecuentes en la unidad de cuidado intensivo, con un alto índice de morbimortalidad. Por tal motivo, se convierte en una prioridad identificar, previamente al alta, los factores precipitantes del reingreso, siendo la adherencia al tratamiento y el apoyo social los más importantes. Objetivo: Determinar la relación entre el nivel de adherencia al tratamiento farmacológico y no farmacológico y el apoyo social de pacientes con falla cardiaca (FC). Metodología: Se realizó un estudio correlacional con un tamaño de muestra de 64 pacientes con diagnóstico de FC. Se utilizó un muestreo no probabilístico. Para la medición del nivel de adherencia se utilizó la escala para evaluación de comportamientos de adherencia con una alfa de Cronbach de 0,72, y para el apoyo social la escala Medical Outcomes Study Social Supportsurvey (MOS) con una alfa de Cronbach de 0,94. Se realizó un análisis descriptivo y se aplicó la prueba de independencia de distribuciones categóricas de Fisher para establecer la relación del nivel de adherencia con el apoyo social. Resultados: La mayoría de los participantes tenían un nivel de frecuentemente adheridos al tratamiento (78%). El índice global de apoyo social fue nivel medio (media: 76,18- DE +-16,5). Se encontró una asociación moderada entre el nivel de apoyo emocional (p: 0,006336) y apoyo afectivo (p: 0,03025) con la adherencia al tratamiento. Conclusiones: Es fundamental que el profesional de enfermería incluya la evaluación del apoyo social previamente al alta, para optimizar los niveles de adherencia. Palabras clave: Apoyo social, cumplimiento y adherencia al tratamiento, insuficiencia cardiaca (DeCS)

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Protocol-based follow-up program for heart failure patients: Impact on prognosis and quality of life

Cited by 15 publications

References 33 publications

Early emergency readmission frequency as an indicator of short-, medium- and long-term mortality post-discharge from hospital

Early emergency readmission frequency as an indicator of short-, medium- and long-term mortality post-discharge from hospital

Non‐invasive telemonitoring improves outcomes in heart failure with reduced ejection fraction: a study in high‐risk patients

Relación entre nivel de adherencia al tratamiento y apoyo social en pacientes con falla cardiaca de enero a noviembre de 2020 en Bogotá

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