Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L'Hospitalet de Llobregat, Barcelona, Spain.
Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
PLoS One. 2023 Feb 7;18(2):e0279815. doi: 10.1371/journal.pone.0279815. eCollection 2023.
Heart failure (HF) programs successfully reduce 30-day readmissions. However, conflicting data exist about its sustained effects afterwards and its impact on mortality. We evaluated whether the impact of a new nurse-led coordinated transitional HF program extends to longer periods of time, including 90 and 180 days after discharge.
We designed a natural experiment to undertake a pragmatical evaluation of the implementation of the program. We compared outcomes between patients discharged with HF as primary diagnosis in Period #1 (pre-program; Jan 2017-Aug 2017) and those discharged during Period #2 (HF program; Sept 2017-Jan 2019). Primary endpoint was the composite of all-cause death or all-cause hospitalization 90 and 180 days after discharge. 440 patients were enrolled: 123 in Period #1 and 317 in Period #2. Mean age was 75±9 years. There were more females in Period #2 (p = 0.025), with no other significant differences between periods. The primary endpoint was significantly reduced in the HF program group, at 90 [adjusted OR 0.31 (0.18-0.53), p <0.001] and at 180 days [adjusted OR 0.18 (CI 0.11-0.32), p <0.001]. Such a decrease was due to a reduction in cardiovascular (CV) and HF hospitalization. All-cause death was reduced when a double check discharge planning was implanted compared to usual care [0 (0%) vs. 7 (3.8%), p = 0.022].
A new nurse-led coordinated transitional bundle of interventions model reduces the composite endpoint of all-cause death and all-cause hospitalization both at 90 and 180 days after a discharge for HF, also in high-risk populations. Such a decrease is driven by a reduction of CV and HF hospitalization. Reduction of all-cause mortality was also observed when the full model including a more exhaustive discharge planning process was implemented.
心力衰竭（HF）项目成功降低了 30 天再入院率。然而，关于其后续持续效果及其对死亡率的影响的数据存在冲突。我们评估了新的护士主导的协调过渡 HF 项目的影响是否会扩展到更长的时间，包括出院后 90 天和 180 天。
我们设计了一项自然实验，对该项目的实施进行了实用评估。我们比较了第 1 期（计划前；2017 年 1 月至 2017 年 8 月）和第 2 期（HF 计划；2017 年 9 月至 2019 年 1 月）出院时 HF 为主要诊断的患者的结局。主要终点是出院后 90 和 180 天全因死亡或全因住院的复合结局。共纳入 440 例患者：第 1 期 123 例，第 2 期 317 例。平均年龄为 75±9 岁。第 2 期女性比例更高（p = 0.025），但两期之间无其他显著差异。HF 项目组的主要终点显著降低，在 90 天时[调整后的 OR 0.31（0.18-0.53），p <0.001]和 180 天时[调整后的 OR 0.18（0.11-0.32），p <0.001]。这种下降归因于心血管（CV）和 HF 住院率的降低。与常规护理相比，实施双检查出院计划时全因死亡降低[0（0%）vs. 7（3.8%），p = 0.022]。
新的护士主导的协调过渡干预措施可降低 HF 出院后 90 天和 180 天的全因死亡和全因住院复合终点，高危人群也有此获益。这种下降是由 CV 和 HF 住院率的降低驱动的。当实施包括更详尽出院计划流程的完整模型时，也观察到全因死亡率的降低。
