Efecto de la implantación del cuidado transicional en una unidad de insuficiencia cardiaca tras un ingreso por insuficiencia cardiaca aguda

Abstract

Introduction and objectivesCurrent heart failure (HF) guidelines recommend implementing specific and coordinated HF-programs in which HF-units are crucial. This study aimed to evaluate the effect of a dedicated transitional care program following a hospitalization for acute HF in a specialized HF-unit. MethodsThis is an observational study that included all the patients discharged for acute HF in a third level center for 13 years (2004-2017). Since 2010, the clinical follow-up was performed by a multidisciplinary HF team on a HF-unit. Two chronological cohorts were compared, before (2004-2009) and after the implementation of the HF-unit (2010-2017). We evaluated the risk of repeated HF-hospitalizations and death between both cohorts. Cox regression and negative binomial regression were used for statistics. ResultsWe included 2814 patients discharged for acute HF. Median (p25-p75) follow-up was 3.7 (1.1-5.7) years. During the HF unit period, the number of patients visited by the physician increased (3.5±1.7 vs 1.7±1.7 per person-year, P=.001). After adjusting for traditional prognosticators, patients belonging to the HF-unit period exhibited a lower risk of all-cause death (HR, 0.84; 95%CI, 0.76-0.94; P=.003), cardiovascular death (HR, 0.80; 95%CI, 0.71-0.92; P=.001) and recurrent HF-hospitalizations (IRR, 0.75; 95%CI, 0.65-0.85; P <.001). ConclusionsImplementation of a HF-unit in a single-teaching center resulted in a significant reduction of long-term death and repeated HF-hospitalizations following and episode of acute HF.