title: Inclusion into a heart failure critical pathway reduces the risk of death or readmission after hospital discharge.
abstract: BACKGROUND
  Evidence-based therapies can lower the risk of death or hospital admission in heart failure (HF) patients, but are underprescribed. Critical pathways are one means of supporting systematic use of evidence-based recommendations.
  
  
  METHODS
  Patients admitted for HF in one hospital in 2009 and included in a critical pathway were compared with a control group of patients admitted in 2007. The primary endpoint was the risk of death or readmission within 90 days after discharge. The hazard ratio of death or readmission was evaluated in a multivariate Cox proportional hazard model adjusting for age, sex, co-morbidities, and length of stay.
  
  
  RESULTS
  Three hundred and sixty-three patients were evaluated (151 in the critical pathway and 212 in the control group). Adjusted hazard ratio for death or readmission at 90 days was 0.72 (95 CI 0.51-1.00, p=0.049). Adhesion to guidelines was significantly better for patients included in the critical pathway (p=0.004), with more frequent prescription of beta-blockers (70.9% (95% CI 62.9-78.0) vs. 56.6% (95% CI 49.6-63.4), p=0.006), and evaluation of left ventricular ejection fraction (LVEF, 73.5% (95% CI 65.7-80.3) vs. 57.5% (95% CI 50.6-64.3), p=0.002). Patients with reduced LVEF seem to have benefited the most from the inclusion in the critical pathway.
  
  
  CONCLUSIONS
  Implementation of a critical pathway for patients hospitalized for HF was associated with a 28% reduction of the relative risk of death or readmission and improved adhesion to guidelines.
authors.affiliation: Division of Internal Medicine, Geneva University Hospitals, Switzerland. Nicolas.Garin@hcuge.ch
authors.forename: Nicolas
authors.initials: N
authors.lastname: Garin
authors.forename: Sebastian
authors.initials: S
authors.lastname: Carballo
authors.forename: Eric
authors.initials: E
authors.lastname: Gerstel
authors.forename: René
authors.initials: R
authors.lastname: Lerch
authors.forename: Philippe
authors.initials: P
authors.lastname: Meyer
authors.forename: Maryam
authors.initials: M
authors.lastname: Zare
authors.forename: Alexis
authors.initials: A
authors.lastname: Zawodnik
authors.forename: Arnaud
authors.initials: A
authors.lastname: Perrier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D019091:Critical Pathways / Q000592:standards / Q000706:statistics & numerical data*; D055317:Evidence-Based Practice / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000592:standards; D010351:Patient Discharge / Q000592:standards / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000592:standards / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors