Reduction in hospitalizations and emergency department visits for frail patients with heart failure: Results of the UMIPIC healthcare program

Cerqueiro, J.M.; González-Franco, Álvaro; Montero-Pérez-Barquero, Manuel; Llàcer, Pau; Conde, Alicia; Dávila, M.F.; Carrera, Miguel; Serrado, A.; Suárez, Isabelle; Pérez-Silvestre, José; Satué, J.A.; Arévalo‐Lorido, J.C.; Rodríguez, A.; Herrero, Astrid; Jordana, R.; Manzano, Luís

doi:10.1016/j.rceng.2015.09.003

Cited by 7 publications

(8 citation statements)

References 30 publications

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“…First, we believe that heart failure care in older patients should be based on best practice and guidelines, including access to advanced therapies and devices, derived from younger populations and applied appropriately for older patients. Second, heart failure care in older patients should be carried out by appropriately experienced multidisciplinary teams consisting at a minimum of specialist nurses, physicians, dieticians and social workers across the primary and secondary care interface using a holistic approach such as that being established in a network of Spanish centres [18]. Third, heart failure is a chronic condition that requires decisions to be made at each stage of care including provision of palliative care to keep patients comfortable when the condition progresses to a terminal stage.…”

Section: Manuscriptmentioning

confidence: 99%

“…According to the National Institute for Health and Care Excellence patients with heart failure should receive a specialist assessment within 2 weeks of hospital discharge [10], however the proportion of older patients seen within the recommended 2 weeks of discharge is only about 2% [25]. A key part of managing heart failure in older patients is through specialised units for inpatient and outpatient management with easy access to experts in the field [18].…”

Section: Manuscriptmentioning

confidence: 99%

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New horizons in management of heart failure in older patients

Stefil

Manzano

Montero-Pérez-Barquero

et al. 2019

Age and Ageing

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Heart failure has a high prevalence in older populations, is a common and growing cause for hospital admission and carries a high risk of morbidity and mortality. Important co-morbidities in older patients with heart failure include atrial fibrillation, renal impairment, hypertension and anaemia. Diagnosing and managing heart failure in older patients are complicated due to atypical presentations, co-morbidities and a relative lack of evidence for commonly used treatments in younger patients. The growing epidemic of heart failure is also under-recognised and resourced in most health systems. Despite potential differences, we recommend that the basic approach to manage heart failure patients with an ejection fraction (EF) of <40% should be the same in older and younger. These treatments need to be started at low doses and titrated slowly along with the management of co-morbidities. Older patients with EF 40–49% can be treated in a similar manner to those with <40%, while the treatment of those with EF ≥50% is pragmatic in nature based on symptom control and management of co-morbidities although the evidence base for these recommendations is lacking. Overall management must be holistic and continuous based on the patient’s social circumstances and ongoing needs. Finally, there is an urgent need for more research, evidence and resources directed towards older populations with heart failure to improve their care and the quality of life.

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Section: Manuscriptmentioning

confidence: 99%

Section: Manuscriptmentioning

confidence: 99%

New horizons in management of heart failure in older patients

Stefil

Manzano

Montero-Pérez-Barquero

et al. 2019

Age and Ageing

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“…The initial implementation of these units has shown a highly significant reduction in hospital readmissions for this type of patient. 26 …”

Section: Integrated and Structured Assessment And Intervention For Pamentioning

confidence: 99%

“…Therefore, we cannot talk about a ''class effect'' in these organizational models. 4,5,7,16 Thus, the quality programs launched by the Spanish Society of Cardiology (SEC-Excelente) 25 and the Spanish Society of Internal Medicine (UMIPIC) 26 aim to establish quality standards in the organization of HF care in Spain.…”

Section: Introductionmentioning

confidence: 99%

Transitions of Care Between Acute and Chronic Heart Failure: Critical Steps in the Design of a Multidisciplinary Care Model for the Prevention of Rehospitalization

Comín‐Colet

Enjuanes

Lupón

et al. 2016

Revista Española de Cardiología (English Edition)

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Despite advances in the treatment of heart failure, mortality, the number of readmissions, and their associated health care costs are very high. Heart failure care models inspired by the chronic care model, also known as heart failure programs or heart failure units, have shown clinical benefits in high-risk patients. However, while traditional heart failure units have focused on patients detected in the outpatient phase, the increasing pressure from hospital admissions is shifting the focus of interest toward multidisciplinary programs that concentrate on transitions of care, particularly between the acute phase and the postdischarge phase. These new integrated care models for heart failure revolve around interventions at the time of transitions of care. They are multidisciplinary and patient-centered, designed to ensure continuity of care, and have been demonstrated to reduce potentially avoidable hospital admissions. Key components of these models are early intervention during the inpatient phase, discharge planning, early postdischarge review and structured follow-up, advanced transition planning, and the involvement of physicians and nurses specialized in heart failure. It is hoped that such models will be progressively implemented across the country.

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“…3 One such morbidity is frailty, a disorder characterized by increased physiologic vulnerability to stressors that increases with age and, like heart failure, is most prevalent in the elderly. 4,5 Multi-morbidity and frailty in patients with heart failure are associated with worse health outcomes. 3,6 This complicates the development and progression of heart failure, and its management at all levels of care within the health system, including primary, secondary and tertiary care, resulting in a significant treatment burden on the patient and hindering an individualized approach to care, which has otherwise been shown to improve outcomes for this patient population.…”

Section: Introductionmentioning

confidence: 99%

Improving the design of heart failure care from the perspective of frontline providers and administrators: A qualitative case study of a large, urban health system

et al. 2020

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Background: Heart failure patients often present with frailty and/or multi-morbidity, complicating care and service delivery. The Chronic Care Model (CCM) is a useful framework for designing care for complex patients. It assumes responsibility of several actors, including frontline providers and health-care administrators, in creating conditions for optimal chronic care management. This qualitative case study examines perceptions of care among providers and administrators in a large, urban health system in Canada, and how the CCM might inform redesign of care to improve health system functioning. Methods: Sixteen semi-structured interviews were conducted between August 2014 and January 2016. Interpretive analysis was conducted to identify how informants perceive care among this population and the extent to which the design of heart failure care aligns with elements of the CCM. Results: Current care approaches could better align with CCM elements. Key changes to improve health system functioning for complex heart failure patients that align with the CCM include closing knowledge gaps, standardizing treatment, improving interdisciplinary communication and improving patient care pathways following hospital discharge. Conclusions: The CCM can be used to guide health system design and interventions for frail and multi-morbid heart failure patients. Addressing care- and service-delivery barriers has important clinical, administrative and economic implications.

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Reduction in hospitalizations and emergency department visits for frail patients with heart failure: Results of the UMIPIC healthcare program

Cited by 7 publications

References 30 publications

New horizons in management of heart failure in older patients

New horizons in management of heart failure in older patients

Transitions of Care Between Acute and Chronic Heart Failure: Critical Steps in the Design of a Multidisciplinary Care Model for the Prevention of Rehospitalization

Improving the design of heart failure care from the perspective of frontline providers and administrators: A qualitative case study of a large, urban health system

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