Abstract
BackgroundAfter hospitalization for cardiac disease, older patients are at high risk of readmission and death. Although geriatric conditions increase this risk, treatment of older cardiac patients is limited to the management of cardiac diseases. The aim of this study is to investigate if unplanned hospital readmission and mortality can be reduced by the Cardiac Care Bridge transitional care program (CCB program) that integrates case management, disease management and home-based cardiac rehabilitation.MethodsIn a randomized trial on patient level, 500 eligible patients ≥ 70 years and at high risk of readmission and mortality will be enrolled in six hospitals in the Netherlands. Included patients will receive a Comprehensive Geriatric Assessment (CGA) at admission. Randomization with stratified blocks will be used with pre-stratification by study site and cognitive status based on the Mini-Mental State Examination (15–23 vs ≥ 24). Patients enrolled in the intervention group will receive a CGA-based integrated care plan, a face-to-face handover with the community care registered nurse (CCRN) before discharge and four home visits post-discharge. The CCRNs collaborate with physical therapists, who will perform home-based cardiac rehabilitation and with a pharmacist who advices the CCRNs in medication management The control group will receive care as usual.The primary outcome is the incidence of first all-cause unplanned readmission or mortality within 6 months post-randomization. Secondary outcomes at three, six and 12 months after randomization are physical functioning, functional capacity, depression, anxiety, medication adherence, health-related quality of life, healthcare utilization and care giver burden.DiscussionThis study will provide new knowledge on the effectiveness of the integration of geriatric and cardiac care.Trial registrationNTR6316. Date of registration: April 6, 2017.
Highlights
After hospitalization for cardiac disease, older patients are at high risk of readmission and death
The RESPONSE study of Jorstad et al [18] involved a nurse-coordinated outpatient intervention that included guidance on lifestyle factors, biometric risk factors and therapy adherence in patients after an acute coronary syndrome. In this disease management approach, a relative risk reduction of 17.4% (P = 0.021) was found on the Systematic Coronary Risk Evaluation (SCORE), which is an integrated measure to estimate the risk of cardiovascular death in 10 years
Serious adverse events after this period are not expected to be caused by the study and will only be recorded during the annual security reports. This protocol for a multi-center randomized controlled trial is designed to prevent hospital readmission and mortality after hospitalization in cardiac patients ≥70 years old who have been admitted to the department of cardiology or cardiothoracic surgery
Summary
After hospitalization for cardiac disease, older patients are at high risk of readmission and death. The failure to recognize geriatric conditions in older cardiac patients negatively impacts treatments post-discharge, e.g. because of nonadherence to (pharmacological) treatment in cognitively impaired patients [4] or poor participation in cardiac rehabilitation programs because of disabilities, the high intensity of these programs [9, 10], fatigue [11] and difficulties traveling to and from cardiac rehabilitation centers [12, 13] This is unfortunate since cardiac rehabilitation has been shown to reduce cardiovascular risk factors, readmission and mortality in older cardiac patients [14]
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