Long-term effectiveness of a nurse-led 7-step transitional intervention programme in heart failure

Abstract

Abstract Background Reduction of 30-day readmission in heart failure (HF) patients is a main goal of health-care systems. Programmes to decrease 30-day readmission have successfully reduced it but have failed to neither maintain benefit afterwards nor decrease mortality. Moreover, in many cases the price of reducing 30-day readmission is a mortality increase. Purpose Evaluate whether the impact of a fully nurse-led HF programme directed to reduce 30-day readmission and mortality extends to longer periods of time, including 90 days and 180 days after discharge. Methods We evaluated all patients discharged from hospital with HF as primary diagnosis between January 2017 and January 2019. We compared outcomes between patients discharged during Period #1 (pre-programme; Jan 2017 - Aug 2017) and those discharged during Period #2 (HF programme; Sept 2017 - Jan 2019). Primary endpoint was the combined endpoint of all-cause death or all-cause hospitalization 90 days and 180 days after discharge from the index hospitalization. Results The study enrolled 440 patients: 123 in Period #1 and 317 in Period #2. Mean age was 75±9 years. There was a higher proportion of female patients in Period #2 (38.2% vs 26.8%, p=0.025), with no differences in other baseline characteristics. The combined endpoint of all cause-death and all-cause hospitalization was significantly reduced in patients in the HF programme group, both at 90 days [OR 0.37 (0.22–0.63), p<0.001] and at 180 days [OR 0.27 (CI 0.17–0.43), p<0.001]. Such a decrease was at expense of a reduction in cardiovascular (CV) hospitalization and HF hospitalization. There were no differences between groups in mortality [OR 0.96 (0.18–5.00), p=0.293]. Conclusions A fully nurse-led HF programme reduces the combined endpoint of all-cause death and all-cause hospitalization both at 90 days and 180 days after an index discharge for HF. Such a decrease is driven by a reduction of CV and HF hospitalization, which are maintained over time. There were no differences between groups in mortality. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Hospital Universitari de Bellvitge