CIESP, National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
Health Care Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
BMJ Open. 2020 Dec 29;10(12):e040028. doi: 10.1136/bmjopen-2020-040028.
The aim of this study was to develop consensus among Argentine cardiologists on a care bundle to reduce readmissions of patients with heart failure (HF).
Hospitals and cardiology clinics in Argentina that provide in-hospital care for patients with HF.
Twenty-four cardiology experts participated in the two online rounds and 18 (75%) of them participated in the third-round meeting.
This study used a mixed-method design; it was conducted between August 2019 and January 2020. The development of a care bundle (a set of evidence-based interventions applied to improve clinical outcomes) involved three phases: (1) a literature review to define the list of interventions to be evaluated; (2) a modified Delphi panel to select interventions for the bundle and (3) definition of the HF care bundle. Also, the process included three rounds of scoring.
Twenty-six interventions were evaluated. The interventions in the final bundle covered four categories: medication, continuum of care, lifestyle habits, predischarge tests. These were: medication: beta-blockers, angiotensin receptor neprilysin inhibitors or ACE-inhibitors, furosemide and antimineralocorticoids; continuum of care: follow-up appointment, daily weight monitoring; lifestyle habits: smoking cessation counselling and low-sodium diet; predischarge tests: renal function, ionogram, blood pressure control, echocardiogram and determination of decompensating cause.
Following a systematic mixed-method approach, we have developed a care bundle of interventions that could decrease readmission of patients with HF. The application of this bundle could contribute to scale evidence-based interventions.
本研究旨在就心力衰竭（HF）患者再入院的护理方案达成阿根廷心脏病专家的共识。
阿根廷提供 HF 住院患者院内护理的医院和心脏病学诊所。
24 名心脏病学专家参加了两轮在线会议，其中 18 名（75%）参加了第三轮会议。
本研究采用混合方法设计；于 2019 年 8 月至 2020 年 1 月期间开展。护理方案（一组应用于改善临床结果的基于证据的干预措施）的制定包括三个阶段：（1）文献复习以确定需要评估的干预措施清单；（2）经过修正的德尔菲小组对纳入护理方案的干预措施进行选择；（3）HF 护理方案的定义。此外，该过程还包括三轮评分。
评估了 26 项干预措施。最终方案中的干预措施涵盖四个类别：药物、连续护理、生活习惯、出院前检查。具体包括：药物：β受体阻滞剂、血管紧张素受体脑啡肽酶抑制剂或 ACE 抑制剂、呋塞米和抗盐皮质激素；连续护理：随访预约、每日体重监测；生活习惯：戒烟咨询和低盐饮食；出院前检查：肾功能、离子谱、血压控制、超声心动图和失代偿原因的确定。
采用系统的混合方法，我们制定了一套可降低 HF 患者再入院率的干预护理方案。该方案的应用有助于推广基于证据的干预措施。
