Impact of heart failure management unit on heart failure-related readmission rate and mortality.
BACKGROUND
Heart failure is the leading cause of hospital admissions and an economic burden. In accordance with European guidelines, a dedicated heart failure unit was created in René Dubos Hospital (Pontoise, France) in 2002.


OBJECTIVE
To evaluate the impact of an in-hospital heart failure management unit on heart failure prognosis.


METHODS
We conducted a descriptive study of all-cause in-hospital mortality and heart failure related readmission rates in the year after the first admission for heart failure, from January 1997 to December 2007. The Chi(2) test, a trend test and linear regression were performed.


RESULTS
There were no significant differences in patient characteristics (age, sex, diabetes mellitus, left ventricular ejection fraction<45%) other than renal insufficiency, in patients admitted for heart failure from 1997 to 2007. After the creation of the heart failure unit, we observed a significant decrease in heart failure related readmission rate from 21.7% in 2002 to 15.6% in 2007 (p<0.0001), whereas there was no difference in this rate before the creation of the unit (34.3% in 1997 and in 2001; p=0.90). All-cause in-hospital mortality rate decreased from 9.3% in 1997 to 5.1% in 2007 (p<0.0001) and showed a tendency to decrease after the creation of the heart failure unit (p=0.06).


CONCLUSIONS
Heart failure related readmission rates in new patients in the year after the first admission for heart failure reduced dramatically after the creation of the heart failure unit. All-cause in-hospital mortality in heart failure patients decreased over the 10-year study period.
Zuily
Stéphane
S
Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France.
Jourdain
Patrick
P
Decup
Daniel
D
Agrinier
Nelly
N
Loiret
Jean
J
Groshens
Serge
S
Funck
François
F
Bellorini
Michel
M
Juillière
Yves
Y
Alla
François
F
D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome