Cristina Pacho1, Mar Domingo2, Raquel Núñez3, Josep Lupón4, Pedro Moliner2, Marta de Antonio5, Beatriz González2, Javier Santesmases6, Emili Vela7, Jordi Tor1, Antoni Bayes-Genis8. 1. Servei de Medicina Interna y Unitat de Geriatria d'Aguts, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain. 2. Servei de Cardiologia-Unitat d'IC, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 3. Servei de Medicina Interna y Unitat de Geriatria d'Aguts, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 4. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Servei de Cardiologia-Unitat d'IC, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; CIBER-CV (CB16/11/00403), Instituto de Salud Carlos III, Madrid, Spain. 5. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Servei de Cardiologia-Unitat d'IC, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 6. Servei de Medicina Interna y Unitat de Geriatria d'Aguts, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Servei de Cardiologia-Unitat d'IC, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 7. Divisió d'Anàlisi de la Demanda i l'Activitat, Servei Català de la Salut, Barcelona, Spain. 8. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Servei de Cardiologia-Unitat d'IC, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; CIBER-CV (CB16/11/00403), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: abayesgenis@gmail.com.
Abstract
INTRODUCTION AND OBJECTIVES: Heart failure (HF) is associated with a high rate of readmissions within 30 days postdischarge. Strategies to lower readmission rates generally show modest results. To reduce readmission rates, we developed a STructured multidisciplinary outpatient clinic for Old and frail Postdischarge patients hospitalized for HF (STOP-HF-Clinic). METHODS: This prospective all-comers study enrolled patients discharged from internal medicine or geriatric wards after HF hospitalization. The intervention involved a face-to-face early visit (within 7 days), HF nurse education, treatment titration, and intravenous medication when needed. Thirty-day readmission risk was calculated using the CORE-HF risk score. We also studied the impact of 30-day readmission burden on regional health care by comparing the readmission rate in the STOP-HF-Clinic Referral Area (∼250000 people) with that of the rest of the Catalan Health Service (CatSalut) (∼7.5 million people) during the pre-STOP-HF-Clinic (2012-2013) and post-STOP-HF-Clinic (2014-2015) time periods. RESULTS: From February 2014 to June 2016, 518 consecutive patients were included (age, 82 years; Barthel score, 70; Charlson index, 5.6, CORE-HF 30-day readmission risk, 26.5%). The observed all-cause 30-day readmission rate was 13.9% (47.5% relative risk reduction) and the observed HF-related 30-day readmission rate was 7.5%. The CatSalut registry included 65131 index HF admissions, with 9267 all-cause and 6686 HF-related 30-day readmissions. The 30-day readmission rate was significantly reduced in the STOP-HF-Clinic Referral Area in 2014-2015 compared with 2012-2013 (P < .001), mainly driven by fewer HF-related readmissions. CONCLUSIONS: The STOP-HF-Clinic, an approach that could be promptly implemented elsewhere, is a valuable intervention for reducing the global burden of early readmissions among elder and vulnerable patients with HF.
INTRODUCTION AND OBJECTIVES:Heart failure (HF) is associated with a high rate of readmissions within 30 days postdischarge. Strategies to lower readmission rates generally show modest results. To reduce readmission rates, we developed a STructured multidisciplinary outpatient clinic for Old and frail Postdischarge patients hospitalized for HF (STOP-HF-Clinic). METHODS: This prospective all-comers study enrolled patients discharged from internal medicine or geriatric wards after HF hospitalization. The intervention involved a face-to-face early visit (within 7 days), HF nurse education, treatment titration, and intravenous medication when needed. Thirty-day readmission risk was calculated using the CORE-HF risk score. We also studied the impact of 30-day readmission burden on regional health care by comparing the readmission rate in the STOP-HF-Clinic Referral Area (∼250000 people) with that of the rest of the Catalan Health Service (CatSalut) (∼7.5 million people) during the pre-STOP-HF-Clinic (2012-2013) and post-STOP-HF-Clinic (2014-2015) time periods. RESULTS: From February 2014 to June 2016, 518 consecutive patients were included (age, 82 years; Barthel score, 70; Charlson index, 5.6, CORE-HF 30-day readmission risk, 26.5%). The observed all-cause 30-day readmission rate was 13.9% (47.5% relative risk reduction) and the observed HF-related 30-day readmission rate was 7.5%. The CatSalut registry included 65131 index HF admissions, with 9267 all-cause and 6686 HF-related 30-day readmissions. The 30-day readmission rate was significantly reduced in the STOP-HF-Clinic Referral Area in 2014-2015 compared with 2012-2013 (P < .001), mainly driven by fewer HF-related readmissions. CONCLUSIONS: The STOP-HF-Clinic, an approach that could be promptly implemented elsewhere, is a valuable intervention for reducing the global burden of early readmissions among elder and vulnerable patients with HF.
Authors: Pamela N Peterson; Larry A Allen; Paul A Heidenreich; Nancy M Albert; Ileana L Piña Journal: Circ Heart Fail Date: 2018-10 Impact factor: 8.790
Authors: Nicolas Girerd; Nathan Mewton; Jean-Michel Tartière; Damien Guijarro; Patrick Jourdain; Thibaud Damy; Nicolas Lamblin; Antoni Bayes-Génis; Pierpaolo Pellicori; James L Januzzi; Patrick Rossignol; François Roubille Journal: Eur J Heart Fail Date: 2022-04-27 Impact factor: 17.349
Authors: Cristina Pacho; Mar Domingo; Raquel Núñez; Josep Lupón; Julio Núñez; Jaume Barallat; Pedro Moliner; Marta de Antonio; Javier Santesmases; Germán Cediel; Santiago Roura; M Cruz Pastor; Jordi Tor; Antoni Bayes-Genis Journal: BMC Geriatr Date: 2018-05-09 Impact factor: 3.921