title: Early Postdischarge STOP-HF-Clinic Reduces 30-day Readmissions in Old and Frail Patients With Heart Failure.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Servei de Medicina Interna y Unitat de Geriatria d'Aguts, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Pacho
authors.affiliation: Servei de Cardiologia-Unitat d'IC, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Domingo
authors.affiliation: Servei de Medicina Interna y Unitat de Geriatria d'Aguts, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Núñez
authors.affiliation: Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Servei de Cardiologia-Unitat d'IC, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; CIBER-CV (CB16/11/00403), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Lupón
authors.affiliation: Servei de Cardiologia-Unitat d'IC, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Moliner
authors.affiliation: Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Servei de Cardiologia-Unitat d'IC, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: de Antonio
authors.affiliation: Servei de Cardiologia-Unitat d'IC, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: González
authors.affiliation: Servei de Medicina Interna y Unitat de Geriatria d'Aguts, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Servei de Cardiologia-Unitat d'IC, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Santesmases
authors.affiliation: Divisió d'Anàlisi de la Demanda i l'Activitat, Servei Català de la Salut, Barcelona, Spain.
authors.forename: Emili
authors.initials: E
authors.lastname: Vela
authors.affiliation: Servei de Medicina Interna y Unitat de Geriatria d'Aguts, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Tor
authors.affiliation: Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Servei de Cardiologia-Unitat d'IC, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; CIBER-CV (CB16/11/00403), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: abayesgenis@gmail.com.
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D002316:Cardiotonic Agents / Q000008:administration & dosage; D004232:Diuretics / Q000008:administration & dosage; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage; D016330:Frail Elderly; D005665:Furosemide / Q000008:administration & dosage; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008320:Maltose / Q000008:administration & dosage / Q000031:analogs & derivatives; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D055502:Secondary Prevention / Q000379:methods
chemical_list: D002316:Cardiotonic Agents; D004232:Diuretics; D005290:Ferric Compounds; C522335:ferric carboxymaltose; D008320:Maltose; D005665:Furosemide
keywords: Ancianos; Cuidados transicionales; Elderly; Heart failure; Insuficiencia cardiaca; Multidisciplinariedad; Multidisciplinarity; Rehospitalizaciones; Rehospitalizations; Transitional care