Implementation and certification of a heart failure clinical care program in a middle income country: impact in clinical outcomes after 2 years
Pedro Gabriel MB Silva, Antonio Baruzzi, Douglas Ribeiro, Flavio Brito, Giuliano Generoso, Jose Teixeira, Marcelo Jamus, Mariana Okada, Thiago Macedo, Valter Furlan
Abstract
| Pre-CCP (historical group) | CCP (intervention group) | |
|---|---|---|
| Number of patients | 338 | 1850 |
| Mean age | 71 (±13.5) | 69 (±11.2) |
| Male (%) | 55% (95% CI: 50-60%) | 56% (95% CI: 54-58%) |
| Mean EF (%) | 37% (±13.3) | 42% (±11.1) |
| Hemodynamic profile C (%) | 5.65% (CI95%: 3-8%) | 4.2% (95% CI: 3.4-5.2%) |
| Ischemic cardiopathy (%) | 48.2% (CI95%: 43-53.5%) | 58% (95% CI: 56-60%) |
| HFpEF (%) | 37% (CI95%: 32-42%) | 27% (95% CI: 25-29%) |
| Cardiorenal syndrome (%) | 35% (CI95%: 30-40%) | 33% (95% CI: 31-35%) |
| Infection (%) | 23% (95% CI: 19-28%) | 22% (95% CI: 20-24%) |
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Taxonomy
TopicsHeart Failure Treatment and Management · Health Systems, Economic Evaluations, Quality of Life
Introduction
Clinical care programs (CCP) that monitor and optimize care have the potential to improve outcomes; however, their real benefits are still controversial.
Objective
This study aims to evaluate the hypothesis of benefits in clinical outcomes after 2 years of a CCP.
Methods
Prospective study of consecutive patients hospitalized with HF in a Brazilian private cardiovascular center. Two groups were compared based on the time to CCP initiation: the historical group, compounded by patients from the 6 months prior to CCP (group 1); and the intervention group, compounded by patients admitted with diagnosis of HF from July 2012 until June 2014, the period when patients and staff were monitored on a daily basis by a case manager nurse and a medical leader which provided educational interventions. The CCP was certified by an international society in October 2012.
Results
In a total of 2188 patients, the mean age was 69.3 years and 55.8% were male (Table 1). Evidence-based therapies at hospital discharge (ACEI/ARB and beta-blocker in eligible patients) showed no significant change (95.8% pre-CCP and 97.5% post-CCP; *p *= 0.12). The outcomes analyzed in groups 1 and 2, were, respectively: hospital readmissions due to HF within 30 days (13.9% vs. 9.1%; *p *= 0.008); length of stay (8.9 ± 7.9 days vs. 7.9 ± 5.6 days, *p *= 0.01); decompensation of HF by poor adherence (16.8% vs. 10.5%; *p *= 0.001); and in-hospital mortality (9% vs. 6.9%; *p *= 0.24).
Conclusion
During the 2 years of the CCP there was a reduction of 1 day in the length of stay, and a lower frequency of hospitalizations by poor treatment adherence, and in readmissions in 30 days.