Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2014;67:283-93 - Vol. 67 Num.04 DOI: 10.1016/j.rec.2013.12.005

Efficacy of an Integrated Hospital-primary Care Program for Heart Failure: A Population-based Analysis of 56 742 Patients

Josep Comín-Colet a,b,c,d, José María Verdú-Rotellar b,c,d,e,f, Emili Vela g, Montse Clèries g, Montserrat Bustins g, Lola Mendoza b,h, Neus Badosa a,b,c, Mercè Cladellas c,d, Sofía Ferré b, Jordi Bruguera a,b,c

a Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
b Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain
c Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
d Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
e Institut d’Investigació d’Atenció Primària Jordi Gol, Institut Català de la Salut, Barcelona, Spain
f Centro de Atención Primaria Sant Martí de Provençals, Institut Català de la Salut, Barcelona, Spain
g División de Análisis de la Demanda y la Actividad, Servei Català de la Salut, Barcelona, Spain
h Centro de Atención Primaria Poble Nou, Institut Català de la Salut, Barcelona, Spain

Keywords

Heart failure. Health outcomes. Disease management programs. Chronic care model. Natural experiment.

Abstract

Introduction and objectives

The efficacy of heart failure programs has been demonstrated in clinical trials but their applicability in the real world practice setting is more controversial. This study evaluates the feasibility and efficacy of an integrated hospital-primary care program for the management of patients with heart failure in an integrated health area covering a population of 309 345.

Methods

For the analysis, we included all patients consecutively admitted with heart failure as the principal diagnosis who had been discharged alive from all of the hospitals in Catalonia, Spain, from 2005 to 2011, the period when the program was implemented, and compared mortality and readmissions among patients exposed to the program with the rates in the patients of all the remaining integrated health areas of the Servei Català de la Salut (Catalan Health Service).

Results

We included 56 742 patients in the study. There were 181 204 hospital admissions and 30 712 deaths during the study period. In the adjusted analyses, when compared to the 54 659 patients from the other health areas, the 2083 patients exposed to the program had a lower risk of death (hazard ratio = 0.92 [95% confidence interval, 0.86-0.97]; P = .005), a lower risk of clinically-related readmission (hazard ratio = 0.71 [95% confidence interval, 0.66-0.76]; P < .001), and a lower risk of readmission for heart failure (hazard ratio = 0.86 [95% confidence interval, 0.80-0.94]; P < .001). The positive impact on the morbidity and mortality rates was more marked once the program had become well established.

Conclusions

The implementation of multidisciplinary heart failure management programs that integrate the hospital and the community is feasible and is associated with a significant reduction in patient morbidity and mortality.

1885-5857/© 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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