Early Postdischarge STOP-HF-Clinic Reduces 30-day Readmissions in Old and Frail Patients With Heart Failure

• Published in: Revista española de cardiología (English ed.) 2017-08, Vol.70 (8), p.631-638
• Main Authors: Pacho, Cristina, Domingo, Mar, Núñez, Raquel, Lupón, Josep, Moliner, Pedro, de Antonio, Marta, González, Beatriz, Santesmases, Javier, Vela, Emili, Tor, Jordi, Bayes-Genis, Antoni
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Ambulatory Care - methods; Cardiotonic Agents - administration & dosage; Diuretics - administration & dosage; Erythrocyte Transfusion - statistics & numerical data; Female; Ferric Compounds - administration & dosage; Frail Elderly; Furosemide - administration & dosage; Heart Failure - therapy; Humans; Infusions, Intravenous; Male; Maltose - administration & dosage; Maltose - analogs & derivatives; Middle Aged; Patient Discharge; Patient Readmission - statistics & numerical data; Prospective Studies; Referral and Consultation - statistics & numerical data; Secondary Prevention - methods
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2017.01.003

Heart failure (HF) is associated with a high rate of readmissions within 30 days postdischarge. Strategies to lower readmission rates generally show modest results. To reduce readmission rates, we developed a STructured multidisciplinary outpatient clinic for Old and frail Postdischarge patients hospitalized for HF (STOP-HF-Clinic). This prospective all-comers study enrolled patients discharged from internal medicine or geriatric wards after HF hospitalization. The intervention involved a face-to-face early visit (within 7 days), HF nurse education, treatment titration, and intravenous medication when needed. Thirty-day readmission risk was calculated using the CORE-HF risk score. We also studied the impact of 30-day readmission burden on regional health care by comparing the readmission rate in the STOP-HF-Clinic Referral Area (∼250000 people) with that of the rest of the Catalan Health Service (CatSalut) (∼7.5 million people) during the pre-STOP-HF-Clinic (2012-2013) and post-STOP-HF-Clinic (2014-2015) time periods. From February 2014 to June 2016, 518 consecutive patients were included (age, 82 years; Barthel score, 70; Charlson index, 5.6, CORE-HF 30-day readmission risk, 26.5%). The observed all-cause 30-day readmission rate was 13.9% (47.5% relative risk reduction) and the observed HF-related 30-day readmission rate was 7.5%. The CatSalut registry included 65131 index HF admissions, with 9267 all-cause and 6686 HF-related 30-day readmissions. The 30-day readmission rate was significantly reduced in the STOP-HF-Clinic Referral Area in 2014-2015 compared with 2012-2013 (P < .001), mainly driven by fewer HF-related readmissions. The STOP-HF-Clinic, an approach that could be promptly implemented elsewhere, is a valuable intervention for reducing the global burden of early readmissions among elder and vulnerable patients with HF.