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Efficacy of a hospital-primary care integrated heart failure program: a population-based analysis in 56,742 patients

Session Tackling acute heart failure

Speaker Josep Comin-Colet

Congress : ESC Congress 2014

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure - Other
  • Session type : Abstract Session
  • FP Number : 998

Authors : C Enjuanes Grau (Barcelona,ES), J Comin-Colet (Barcelona,ES), JM Verdu (Barcelona,ES), E Vela (Barcelona,ES), M Cleries (Barcelona,ES), M Bustins (Barcelona,ES), L Mendoza (Barcelona,ES), N Badosa (Barcelona,ES), M Cladellas (Barcelona,ES), J Bruguera (Barcelona,ES)


C. Enjuanes Grau1 , J. Comin-Colet1 , J.M. Verdu2 , E. Vela3 , M. Cleries3 , M. Bustins3 , L. Mendoza4 , N. Badosa1 , M. Cladellas5 , J. Bruguera5 , 1Hospital del Mar, Department of Cardiology, Heart Failure Program - Barcelona - Spain , 2IDIAP Jordi Gol - Barcelona - Spain , 3Divisiόn de Gestion de Registros de Actividad, Servicio Catalan de Salud, Barcelona, Spain - Barcelona - Spain , 4SAP Litoral Mar, Institut Catala de la Salut, Barcelona, Spain - Barcelona - Spain , 5Hospital del Mar, Department of Cardiology - Barcelona - Spain ,

European Heart Journal ( 2014 ) 35 ( Abstract Supplement ), 181

Introduction and objective: : Heart failure programs have proven effective in clinical studies, but its applicability in a real practice environment is more controversial. The present study evaluated the feasibility and efficacy of an integrated primary care-hospital HF management program in an integral healthcare area of 309,345 inhabitants.

Methods: The analysis included all consecutive patients hospitalized for a primary diagnosis of HF and discharged alive in all hospitals during the period 2005-2011 in which the program was implemented and compared mortality and readmissions among patients exposed to the IHFP and all patients exposed to the remaining healthcare areas of the Catalan Healthcare Service.

Results: In this study, 56,742 patients were included. There were 181,204 hospitalizations and 30,712 deaths in this period. In the adjusted analyses, the 2,083 patients exposed to the program, compared to the 54,659 patients exposed to the remaining healthcare areas, had lower risk of death (hazard ratio: 0.92 [0.86-0.97] p=0.005), lower risk of clinically-related readmissions (hazard ratio: 0.71 [from 0.66 to 0.76], p<0.001) and lower risk of readmissions for HF (hazard ratio: 0.86 [0.80-0.94] p<0.001). It was observed that the positive impact on morbidity and mortality was more pronounced in the consolidation period of the program.

Conclusions: The implementation of multidisciplinary heart failure programs integrating hospital and community is feasible and is associated with a significant reduction in morbidity and mortality of patients.

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