title: [Proposed protocol for the ambulatory management of patients discharged with heart failure diagnosis: collaborative project Venice-HF].
abstract: BACKGROUND
  Hospital admissions for heart failure are common and readmission rates are high. Many admissions and readmissions may be avoidable, so that alternative strategies are needed to improve long-term management.
  
  
  METHODS
  We conducted a randomized trial of the effect of a guideline-based intervention on rates of readmission within 90 days of hospital discharge and costs of care for patients who were hospitalized due to decompensated heart failure. The intervention consisted of comprehensive education of the patient and family, a prescribed diet and intensive application of guidelines' recommendations on pharmacological therapy. The intervention started before discharge and continued thereafter with follow-up visits for up to 3 months. Two hundred and nine guideline-managed patients were compared to 209 concurrent normally-discharged patients.
  
  
  RESULTS
  Patients in the study group were more prescribed beta-blockers, ACE-inhibitors, angiotensin receptor blockers, and spironolactone. Sixteen patients (8%) in the intervention group and 31 (15%) among controls were readmitted for DRG 127, within 3 months of discharge (Fisher's exact test, p < 0.01), while the 6-month mortality rate was similar between groups (9 and 11.5% respectively). Quality of life significantly improved from 5.6 +/- 1.0 to 6.1 +/- 1.9 (Mann-Whitney U-test, p < 0.05). The overall costs of care were lower for guideline-managed patients (110 vs 150 Euro per patient per month), due to the lower readmission rates.
  
  
  CONCLUSIONS
  Our study showed that a guideline-based management program for patients with heart failure at discharge improves quality of life and reduces readmission for DRG 127 and total bed days, allowing relevant cost savings.
authors.affiliation: Ambulatorio per lo Scompenso Cardiaco, U.O. di Cardiologia, Ospedale Civile, San Donà di Piave, VE. robertovalle@libero.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Valle
authors.forename: Emanuele
authors.initials: E
authors.lastname: Carbonieri
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Tenderini
authors.forename: Carlo
authors.initials: C
authors.lastname: Zanella
authors.forename: Francesca
authors.initials: F
authors.lastname: De Cian
authors.forename: Giuliana
authors.initials: G
authors.lastname: Ginocchio
authors.forename: Sergio
authors.initials: S
authors.lastname: Cannas
authors.forename: Daniele
authors.initials: D
authors.lastname: Milan
authors.forename: Loredano
authors.initials: L
authors.lastname: Milani
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D002985:Clinical Protocols; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007558:Italy; D008297:Male; D010351:Patient Discharge