Á González-Franco1, J M Cerqueiro González2, J C Arévalo-Lorido3, P Álvarez-Rocha4, S Carrascosa-García5, A Armengou6, M Guzmán-García7, J C Trullàs8, M Montero-Pérez-Barquero9, L Manzano10. 1. Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain. Electronic address: alvarogfranco@yahoo.com. 2. Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain. 3. Servicio de Medicina Interna, Hospital Comarcal de Zafra, Zafra, Badajoz, Spain. 4. Servicio de Medicina Interna y Cardiología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay. 5. Servicio de Medicina Interna, Consorcio Hospital General Universitario de Valencia, Valencia, Spain. 6. Servicio de Medicina Interna, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain. 7. Servicio de Medicina Interna, Hospital San Juan de la Cruz, Jaén, Spain. 8. Servicio de Medicina Interna, Hospital d'Olot i comarcal de la Garrotxa, Girona, Spain; Laboratori de Reparació i Regeneració Tissular (TR2Lab), Facultat de Medicina, Universitat de Vic - Universitat Central de Catalunya, Vic, Barcelona, Spain. 9. Servicio de Medicina Interna, IMIBIC/Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain. 10. Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain.
Abstract
BACKGROUND: Elderly patients with heart failure (HF) have a high degree of comorbidity which leads to fragmented care, with frequent hospitalizations and high mortality. This study evaluated the benefit of a comprehensive continuous care model (UMIPIC program) in elderly HF patients. METHODS AND RESULTS: We prospectively analyzed data from the RICA registry on 2862 patients with HF treated in internal medicine departments. They were divided into two groups: one monitored in the UMIPIC program (UMIPIC group, n: 809) and another which received conventional care (RICA group, n: 2.053). We evaluated HF readmissions during 12 months of follow-up and total mortality after episodes of HF hospitalization. UMIPIC patients were older with higher rates of comorbidity and preserved ejection fraction than the RICA group. However, the UMIPIC group had a lower rate of HF readmissions (17% vs. 26%, p < .001) and mortality (16% vs. 27%, respectively; p < .001). In addition, we selected 370 propensity score-matched patients from each group and the differences in HF readmissions (15% UMIPIC vs. 30% RICA; hazard ratio [HR] = 0.44; 95% confidence interval [CI] 0.32-0.60; p < .001) and mortality (17% UMIPIC vs. 28% RICA; hazard ratio = 0.58; 95% CI 0.42-0.79; p = .001) were maintained. CONCLUSIONS: The implementation of the UMIPIC program, based on comprehensive continuous care of elderly patients with HF and high comorbidity, markedly reduce HF readmissions and total mortality.
BACKGROUND: Elderly patients with heart failure (HF) have a high degree of comorbidity which leads to fragmented care, with frequent hospitalizations and high mortality. This study evaluated the benefit of a comprehensive continuous care model (UMIPIC program) in elderly HF patients. METHODS AND RESULTS: We prospectively analyzed data from the RICA registry on 2862 patients with HF treated in internal medicine departments. They were divided into two groups: one monitored in the UMIPIC program (UMIPIC group, n: 809) and another which received conventional care (RICA group, n: 2.053). We evaluated HF readmissions during 12 months of follow-up and total mortality after episodes of HF hospitalization. UMIPIC patients were older with higher rates of comorbidity and preserved ejection fraction than the RICA group. However, the UMIPIC group had a lower rate of HF readmissions (17% vs. 26%, p < .001) and mortality (16% vs. 27%, respectively; p < .001). In addition, we selected 370 propensity score-matched patients from each group and the differences in HF readmissions (15% UMIPIC vs. 30% RICA; hazard ratio [HR] = 0.44; 95% confidence interval [CI] 0.32-0.60; p < .001) and mortality (17% UMIPIC vs. 28% RICA; hazard ratio = 0.58; 95% CI 0.42-0.79; p = .001) were maintained. CONCLUSIONS: The implementation of the UMIPIC program, based on comprehensive continuous care of elderly patients with HF and high comorbidity, markedly reduce HF readmissions and total mortality.
Authors: Juan Torres-Macho; Jose Manuel Cerqueiro-González; Jose Carlos Arévalo-Lorido; Pau Llácer-Iborra; Jose María Cepeda-Rodrigo; Pilar Cubo-Romano; Jose Manuel Casas-Rojo; Raúl Ruiz-Ortega; Luis Manzano-Espinosa; Noel Lorenzo-Villalba; Manuel Méndez-Bailón Journal: J Clin Med Date: 2022-08-22 Impact factor: 4.964