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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:631-8 - Vol. 70 Num.08 DOI: 10.1016/j.rec.2017.01.003

Early Postdischarge STOP-HF-Clinic Reduces 30-day Readmissions in Old and Frail Patients With Heart Failure

Cristina Pacho a,b, Mar Domingo c, Raquel Núñez a, Josep Lupón b,c,d, Pedro Moliner c, Marta de Antonio b,c, Beatriz González c, Javier Santesmases a,c, Emili Vela e, Jordi Tor a,b, Antoni Bayes-Genis b,c,d,

a Servei de Medicina Interna y Unitat de Geriatria d’Aguts, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
b Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
c Servei de Cardiologia-Unitat d’IC, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
d CIBER-CV (CB16/11/00403), Instituto de Salud Carlos III, Madrid, Spain
e Divisió d’Anàlisi de la Demanda i l’Activitat, Servei Català de la Salut, Barcelona, Spain

Refers to

Free articleDo All Patients With Heart Failure Benefit From a Program for Early Follow-up After Hospital Discharge?
Manuel Anguita Sánchez, Juan C. Castillo Domínguez
Rev Esp Cardiol. 2017;70:624-5
Full text - PDF

Keywords

Heart failure. Rehospitalizations. Elderly. Transitional care. Multidisciplinarity.

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 (∼250 000 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 65 131 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.

1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved