Heart Failure's First Shock and Nurse-Led Chronic Care

TL;DR

This study examines how a first heart failure hospitalization affects patient care behaviors and assesses whether a nurse-led program sustains these changes, revealing immediate post-shock improvements and long-term preventive engagement.

Contribution

It provides empirical evidence on the dynamic effects of heart failure shocks and evaluates the long-term impact of a nurse-led chronic care program using linked administrative data.

Findings

Post-shock surge in medication adherence and follow-up care

Nurse-led program enhances long-term preventive engagement

Limited impact on emergency-room use after program implementation

Abstract

We study how a first heart-failure hospitalization, an adverse health shock, changes patients' care, and whether a nurse-led chronic-care program sustains those post-shock investments. Using linked population-wide administrative records from Italy's Romagna Local Health Authority (2017-2023), we anchor event time at each patient's first CHF admission and exploit staggered timing to estimate dynamic effects. The shock triggers a sharp post-discharge surge: beta-blocker adherence, cardiology follow-up, and echocardiography rise immediately, while emergency-room use spikes just before admission and then stabilizes. We then estimate the incremental impact of enrollment in the Nurse-led Program for Chronic Patients (NPCP) using the interaction-weighted event-study estimator for staggered adoption. Under conventional difference-in-differences inference, NPCP strengthens long-run preventive engagement, with little detectable change in emergency-room use. HonestDiD sensitivity analysis indicates these gains are economically meaningful but not statistically definitive under modest departures from parallel trends.