Association of a Transitional Heart Failure Management Program With Readmission and End-of-Life Care in Rural Japan - PubMed (original) (raw)

. 2024 Apr 20;6(5):168-177.

doi: 10.1253/circrep.CR-24-0030. eCollection 2024 May 10.

Kensuke Nakamura 1, Masayuki Hirai 1, Midori Manba 2, Natsuko Ishiga 3, Takeshi Sota 3, Natsuko Nakayama 4, Tomoki Ohta 5, Masahiko Kato 6, Toshiaki Adachi 7, Masaharu Fukuki 8, Yutaka Hirota 9, Einosuke Mizuta 10, Emiko Mura 11, Yoshihito Nozaka 12, Hiroki Omodani 13, Hiroaki Tanaka 14, Yasunori Tanaka 15, Izuru Watanabe 16, Masaaki Mikami 17, Kazuhiro Yamamoto 1

Affiliations

Association of a Transitional Heart Failure Management Program With Readmission and End-of-Life Care in Rural Japan

Yoshiharu Kinugasa et al. Circ Rep. 2024.

Abstract

Background: Evidence on transitional care for heart failure (HF) in Japan is limited. Methods and Results: We implemented a transitional HF management program in rural Japan in 2019. This involved collaboration with general practitioners or nursing care facilities and included symptom monitoring by medical/nursing staff using a handbook; standardized discharge care planning and information sharing on self-care and advance care planning using a collaborative sheet; and sharing expertise on HF management via manuals. We compared the outcomes within 1 year of discharge among patients hospitalized with HF in the 2 years before program implementation (2017-2018; historical control, n=198), in the first 2 years after program implementation (2019-2020; Intervention Phase 1, n=205), and in the second 2 years, following program revision and regional dissemination (2021-2022; Intervention Phase 2, n=195). HF readmission rates gradually decreased over Phases 1 and 2 (P<0.05). This association was consistent regardless of physician expertise, follow-up institution, or the use of nursing care services (P>0.1 for interaction). Mortality rates remained unchanged, but significantly more patients received end-of-life care at home in Phase 2 than before (P<0.05). Conclusions: The implementation of a transitional care program was associated with decreased HF readmissions and increased end-of-life care at home for HF patients in rural Japan.

Keywords: Discharge care planning; General practitioners; Heart failure handbook; Information sharing.

Copyright © 2024, THE JAPANESE CIRCULATION SOCIETY.

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Conflict of interest statement

Y.K. has received lecturer fees from AstraZeneca Co. Ltd and Boehringer Ingelhem Co., Ltd. K.Y. has received research grants from Abbott Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Biotronik Japan Inc., Japan Lifeline Co., Ltd., Fukuda Denshi; Medtronic Japan Co., Ltd., and Boston Scientific Co., Ltd., as well as lecturer fees from Otsuka Pharmaceutical Co., Ltd., Novartis, Daiichi-Sankyo Co. Ltd., and Bayer Yakuhin Ltd. The remaining authors have no conflicts of interest to declare.

Figures

Figure 1.

Figure 1.

Transitional heart failure (HF) management program in western Tottori Prefecture. GPs, general practitioners. Reproduced with permission from the Western Tottori Medical Association.

Figure 2.

Figure 2.

History of development and implementation of the transitional heart failure (HF) management program.

Figure 3.

Figure 3.

Clinical outcomes for the historical control, Phase 1, and Phase 2 groups: (A) all-cause mortality; (B) heart failure (HF) rehospitalization.

Figure 4.

Figure 4.

Subgroup analysis of the effects of the transitional program on heart failure (HF) readmission showing historical control vs. Phase 1 (Left) and Phase 2 (Right). Cox hazard models were adjusted for albumin concentrations and the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, angiotensin receptor-neprilysin inhibitor, sodium-glucose cotransporter 2 inhibitors, and tolvaptan. Dashed lines indicate a hazard ratio of 0.5. MAGGIC, Meta-Analysis Global Group in Chronic Heart Failure.

Figure 5.

Figure 5.

Rates of patients receiving end-of-life care at home in the (A) historical control, Phase 1, and Phase 2 groups and (B) pre-Phase 2 (historical control plus Phase 1) and Phase 2 groups.

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