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Early Postdischarge STOP-HF-Clinic Reduces 30-day Readmissions in Old and Frail Patients With Heart Failure.
- Source :
-
Revista espanola de cardiologia (English ed.) [Rev Esp Cardiol (Engl Ed)] 2017 Aug; Vol. 70 (8), pp. 631-638. Date of Electronic Publication: 2017 Feb 16. - Publication Year :
- 2017
-
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).<br />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.<br />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.<br />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.<br /> (Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Ambulatory Care methods
Cardiotonic Agents administration & dosage
Diuretics administration & dosage
Erythrocyte Transfusion statistics & numerical data
Female
Ferric Compounds administration & dosage
Frail Elderly
Furosemide administration & dosage
Humans
Infusions, Intravenous
Male
Maltose administration & dosage
Maltose analogs & derivatives
Middle Aged
Patient Discharge
Prospective Studies
Referral and Consultation statistics & numerical data
Secondary Prevention methods
Heart Failure therapy
Patient Readmission statistics & numerical data
Subjects
Details
- Language :
- English; Spanish; Castilian
- ISSN :
- 1885-5857
- Volume :
- 70
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Revista espanola de cardiologia (English ed.)
- Publication Type :
- Academic Journal
- Accession number :
- 28215922
- Full Text :
- https://doi.org/10.1016/j.rec.2017.01.003