Multicenter randomized trial of a comprehensive hospital discharge and outpatient heart failure management program.
OBJECTIVE
Disease management programs can reduce hospitalizations in high-risk heart failure (HF) patients, but generalizability to the population hospitalized for HF remains to be proven. We aimed to assess the effectiveness of a discharge and outpatient management program in a non-selected cohort of patients hospitalized for HF.


RESULTS
Patients admitted with decompensated HF were randomized to receive usual care (n=174) or an intervention (n=164) consisting of a comprehensive hospital discharge planning and close follow-up at a HF clinic. After a median of 509 days, there were fewer events (readmission or death) in the intervention as compared with the control group (156 vs. 250), which represents 47% (95%CI: 29-65; P<0.001) event reduction per observation year. At 1-year, time to first event, time to first all-cause and HF readmission, and time to death were increased in the intervention group (P<0.001). All-cause and HF readmission rates per observation year were significantly lower, quality of life improved and overall cost of care was reduced in the intervention group.


CONCLUSIONS
This comprehensive hospital discharge and outpatient management program prolonged time to first event, reduced hospital readmissions, improved survival and quality of life of patients hospitalized for HF, while reducing cost of management.
Department of Cardiology, Hospital General Universitario de Valencia, Valencia, Spain. fatienza@meditex.es
Felipe
F
Atienza
Manuel
M
Anguita
Nieves
N
Martinez-Alzamora
Joaquín
J
Osca
Soledad
S
Ojeda
Luis
L
Almenar
Francisco
F
Ridocci
Federico
F
Vallés
José A
JA
de Velasco
D000553:Ambulatory Care; D003266:Continuity of Patient Care; D019468:Disease Management; D018572:Disease-Free Survival; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D006801:Humans; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D010359:Patient Readmission; D011788:Quality of Life; D013030:Spain