Reduction in hospitalizations and emergency department visits for frail patients with heart failure: Results of the UMIPIC healthcare program (original) (raw)
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Organization of Heart Failure Care in Spain: Characteristics of Heart Failure Units
Revista Española de Cardiología (English Edition), 2015
To the Editor, Heart failure (HF) is a major health problem, and the burden it places on health care systems and society in general has increased in recent years and is expected to continue to grow. 1 Due to the wide diversity of patients with very different prognoses and therapeutic options, current guidelines recommend a multidisciplinary approach and the establishment of organizational structures to guarantee its implementation (recommendation class I A). 2 Here we present the results of the MOSAIC (Mapa de la Organización de la Insuficiencia Cardiaca en España [Map of Heart Failure Organization in Spain]) project, which updates and expands the information available about resources and organizational structures in Spain for the care of patients with HF 3 and complements the data from other recent studies conducted by the Spanish Society of Cardiology. 4 We contacted 219 of the 246 hospitals listed (89%) in the general catalog of the Spanish Ministry of Health, Social Services, and Equality (Ministerio de Sanidad, Servicios Sociales e Igualdad [MSSSI]) 5 ; 60 hospitals declined to participate, and 8 were excluded due to insufficient data. We thus present information from 151 hospitals, obtained by an online and telephone survey in the last quarter of 2011. The hospitals were classified into 3 groups according to the complexity of health care provision: level 1 (no hemodynamic monitoring, electrophysiology, or cardiac surgery), level 2 (hemodynamic monitoring and/or electrophysiology, but no surgery), and level 3 (hemodynamic monitoring, electrophysiology, and surgery). The study examined 2 types of HF unit. A general unit is a designated hospital service with an assigned manager and a specific protocol for the care of HF patients. An advanced unit has resources for the treatment of critically ill patients, including the management of advanced HF, pretransplant evaluation, hemodynamic monitoring, and ability to recommend implantation of an automated implantable cardioverter defibrillator or cardiac resynchronization device. The survey included hospitals from all 17 Spanish autonomous regions and Melilla, with a total assigned catchment population of 34.2 million people. Of these centers, 87 (57.6%) are level 1 hospitals, 33 (21.9%) are level 2, and 31 (20.5%) are level 3, the most complex level. The annual median number [interquartile range] of hospital discharges of patients admitted for all causes was 9220 [4433-20 648], and the annual number of discharges of patients admitted for HF as the main cause was 409 [156-687]. The Figure shows the proportion of centers with an HF unit broken down by unit type and compares these data with the situation in 2006 3 (although that publication did not describe the criteria used to define the hospital type, which may have differed from those used here). Of the 151 centers, 56 (37.1%) have HF units. Of these, 16 are level 1 centers (28.6% of all units), 14 (25%) are level 2 centers, and 26 (46.4%) are level 3 centers. Heart failure units are currently found in 18.4% of level 1 centers, 42.4% of level 2 centers, and 83.9% of level 3 centers, figures only slightly higher than those for 2006 (P > .05 for all comparisons). Regarding unit type, 26 hospitals have only a general unit (46.4% of centers with an HF unit and 17.2% of the total), 12 have only an advanced unit (21.4% and 7.9%), and 18 have units of both types (32.1% and 11.9%). Centers with an HF unit are larger than those without one, have higher numbers of discharges of patients admitted for all causes (median 18 906 [7962-30 984] vs 6000 [3 498-13 154]) and for HF (661 [358-1027] vs 251 [121-493]), and also have more cardiologists (17 [9-23] vs 4 [2-9]). Of the 44 general HF units (26 as the only HF unit and 18 in centers that also have advanced units), most (n = 37 [84.1%]) are managed by the cardiology service and a few (n = 6 [13.6%]) are managed by internal medicine (the corresponding figures for 2006 were 91% and 9%). The cardiology service participates in 42 of the general units (95.5% vs 96% in 2006), internal medicine in 17 (38.6% vs 11% in 2006), rehabilitation in 9 (20.5% vs 9% in 2006), and geriatrics in 4 (9.1% vs 22% in 2006)-the same
Management of acute heart failure in spanish emergency departments based on age
Revista española de cardiología (English ed.), 2013
To investigate possible age-related differences in the profile, clinical symptoms, management, and short-term outcomes of patients seen for acute heart failure in Spanish emergency departments. We performed a multipurpose, multicenter study with prospective follow-up including all patients with acute heart failure attended in 29 Spanish emergency departments. The following variables were collected: demographic, personal history, geriatric syndromes, data of acute episode, discharge destination, in-hospital and 30-day mortality and 30-day revisit. The sample was divided into 4 age groups: <65, 65-74, 75-84, and ≥85 years. We included 5819 patients: 493 (8.5%) were <65 years old, 971 (16.7%) were 65-74 years old, 2407 (41.4%) were 75-84 years old, and 1948 (33.5%) were ≥85 years old; 4424 patients (76.5%) were admitted from the emergency department, 251 of whom (4.5%) died during hospitalization. Statistically significant differences were observed in relation to cardiovascular r...
Revista Médica de Minas Gerais, 2015
Introduction: heart failure is a crippling disease that reduces the quality of life; therefore, it is a serious public health problem. Objectives: to analyze the epidemiological and assistance care profile of heart failure patients admitted to a regional reference hospital. Statistically correlate clinical signs to diagnostic criteria and admissions to primary care services. To verify consistency between the treatment used and heart failure guidelines. Patients and methods: this was a prevalence, cross-sectional, and an exploratory study conducted through the reading of medical charts from a regional reference hospital from patients whose cause for hospitalization was heart failure in 2010. The data were analyzed in the Epi-Info 3.5 software. Frequency analysis and Odds Ratio (OR) with 95% confidence interval were calculated taking into account the P-value calculated through the Fisher's exact test. The project was approved by the University Ethics Committee (Protocol 159/2011). Results: 54 medical records were analyzed; 81% of patients had access to a primary care unit in the area of their residence. Dyslipidemia was associated with the highest number of hospitalizations (OR = 16/P = 0.034). The primary etiology of heart failure was systemic hypertensive heart disease (72.2%). The main risk factors found were hypertension (66.7%), smoking (48.1%), diabetes mellitus (44.4%), and dyslipidemia (40.7%). Out of the heart failure diagnoses, 68.52% could have been made from the Framingham criteria. Conclusions: permanent education programs are needed for addressing heart failure risk factors, evaluation and adherence to treatment, and active search for cases in the primary care as well as diagnosis of heart failure and its proper management.
2014
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. 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). 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 comp...
Medicina clínica práctica, 2020
To analyze the epidemiological characteristics of heart failure (HF) and estimate the burden of the disease on the health service by means of real world data (RWD). Patients and methods: All patients discharged from any Basque Health Service hospital after a first admission for HF between 2011 and 2015. Data sources: Databases of our health service. Outcomes: 30-and 365-day admissions, potentially avoidable hospitalizations (PAHs), mortality. Statistical analysis: Descriptive statistics, age-standardized event rates. Results: The cohort was composed of 15,109 patients (mean age 79.8 ± 10.1 years). At discharge patients had a median of 8 chronic conditions. 36% of them had had hospitalizations and 83% had visited a specialist (42% of them a cardiologist) during the previous year. Mortality was 24.5% within 365 days after discharge. Within 30 days after discharge, there were 2608 unplanned admissions, 49% for non-cardiovascular disease (CVD), 36% for HF and 15% for a CVD other than HF. 34% were classified as PAH. In the first 365 days after discharge, there were 14,559 hospitalizations, 54% for non-CVD reasons, 32% for HF and 13% for a CVD other than HF. Overall, 35% were PAHs. Conclusion: (1) People admitted for HF are old, and they have multimorbidity and high rates of admissions due to non-CVD reasons and PAHs after discharge. These finding suggest the need of strengthening continuity of care and managing comorbidities. (2) Besides, most people admitted for HF have previous contacts with the Healthcare system, which suggests opportunities for prevention before disease worsening.
Objectives: To provide a database describing the clinical characteristics, treatment patterns, and outcome of patients hospitalized for heart failure. Materials and methods: Descriptive, cross-sectional, "hospital registry" study involving patients older than 18 years of age hospitalized with symptoms or signs suggestive of decompensated acute heart failure. Descriptive statistics were used to report the frequencies and percentages. Results: A total of 1,075 patients were enrolled, mean age was 73.6 ± 10.9 years and 55% of the patients were male. The most frequent medical history was hypertension (52.6%) and coronary heart disease (51%). The population studied had an average blood pressure of 129.5 ± 29.1 mmHg, with predominant tachycardia and tachypnea. The distribution according to the ejection fraction was: heart failure with reduced ejection fraction: 39%, heart failure with ejection fraction medium range: 15% and heart failure with preserved ejection fraction: 46%. The use of converting enzyme inhibitors / angiotensin receptor blockers and beta blockers at hospital discharge was 75.5% and 64.1%, respectively. 29.2% of the patients had previous hospitalizations for heart failure. The hospital stay had a median of 3 days. In-hospital mortality from all causes was 13%. Conclusions: Hospitalization occurs predominantly in elderly patients. Nearly half of the patients have preserved ejection fraction. The use of drugs recommended in the guidelines is low and there is a high in-hospital mortality. Key Words: Heart failure, registry, Peru (source: MeSH NLM)
Revista espanola de cardiologia, 2002
INTRODUCTION AND OBJECTIVES To assess baseline characteristics, management patterns, and clinical outcomes after 18 months in patients diagnosed as heart failure in a tertiary hospital in Catalonia, Spain. METHODS The records of all 265 patients admitted to the Hospital General Vall d'Hebron from July through December 1998 with a diagnosis of heart failure who met study criteria were identified and analyzed. Patients were interviewed by telephone 18 months later. RESULTS The mean age of the study population was 75 12 years, 42% were male, 19% were admitted for causes other than heart failure, and 62% had significant comorbidity. Ventricular function was assessed in 68% (preferentially patients with a better prognosis), and was considered normal in 41%. Angiotensin-converting enzyme inhibitors or angiotensin II antagonists were used in 54%, and beta-blockers in 4%. The 18-month mortality was 46% (77% cardiac mortality). Multivariate predictors of death were older age, severe or p...