Breaking the 30-day barrier: Long-term effectiveness of a nurse-led 7-step transitional intervention program in heart failure

Background and aimsHeart failure (HF) programs successfully reduce 30-day readmissions. However, conflicting data exist about its sustained effects afterwards and its impact on mortality. We evaluated whether the impact of a new nurse-led coordinated transitional HF program extends to longer periods...

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Autores: Alcoberro, Lídia, Moliner, Pedro, Vime, Joan, Jiménez Marrero, Santiago, Garay, Alberto, Yun, Sergi, Pons Riverola, Alexandra, Ramos Polo, Raúl, Ras Jiménez, Maria del Mar, Tajes Orduña, Marta, Hidalgo, Encarna, Calero, Esther, Ruiz, Marta, José Bazán, Nuria, Ferre, Carles, Delso, Cristina, Alcober, Laia, Enjuanes, Cristina, Comín Colet, Josep
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/200921
Acceso en línea:https://hdl.handle.net/2445/200921
Access Level:acceso abierto
Palabra clave:Insuficiència cardíaca
Ingressos i altes en els hospitals
Heart failure
Hospital admission and discharge
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spelling Breaking the 30-day barrier: Long-term effectiveness of a nurse-led 7-step transitional intervention program in heart failureAlcoberro, LídiaMoliner, PedroVime, JoanJiménez Marrero, SantiagoGaray, AlbertoYun, SergiPons Riverola, AlexandraRamos Polo, RaúlRas Jiménez, Maria del MarTajes Orduña, MartaHidalgo, EncarnaCalero, EstherRuiz, MartaJosé Bazán, NuriaFerre, CarlesDelso, CristinaAlcober, LaiaEnjuanes, CristinaComín Colet, JosepInsuficiència cardíacaIngressos i altes en els hospitalsHeart failureHospital admission and dischargeBackground and aimsHeart failure (HF) programs successfully reduce 30-day readmissions. However, conflicting data exist about its sustained effects afterwards and its impact on mortality. We evaluated whether the impact of a new nurse-led coordinated transitional HF program extends to longer periods of time, including 90 and 180 days after discharge. Methods and resultsWe designed a natural experiment to undertake a pragmatical evaluation of the implementation of the program. We compared outcomes between patients discharged with HF as primary diagnosis in Period #1 (pre-program; Jan 2017-Aug 2017) and those discharged during Period #2 (HF program; Sept 2017-Jan 2019). Primary endpoint was the composite of all-cause death or all-cause hospitalization 90 and 180 days after discharge. 440 patients were enrolled: 123 in Period #1 and 317 in Period #2. Mean age was 75 +/- 9 years. There were more females in Period #2 (p = 0.025), with no other significant differences between periods. The primary endpoint was significantly reduced in the HF program group, at 90 [adjusted OR 0.31 (0.18-0.53), p <0.001] and at 180 days [adjusted OR 0.18 (CI 0.11-0.32), p <0.001]. Such a decrease was due to a reduction in cardiovascular (CV) and HF hospitalization. All-cause death was reduced when a double check discharge planning was implanted compared to usual care [0 (0%) vs. 7 (3.8%), p = 0.022]. ConclusionA new nurse-led coordinated transitional bundle of interventions model reduces the composite endpoint of all-cause death and all-cause hospitalization both at 90 and 180 days after a discharge for HF, also in high-risk populations. Such a decrease is driven by a reduction of CV and HF hospitalization. Reduction of all-cause mortality was also observed when the full model including a more exhaustive discharge planning process was implemented.Public Library of Science (PLoS)2023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/200921Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1371/journal.pone.0279815PLOS ONE, 2023, vol. 18, num. 2https://doi.org/10.1371/journal.pone.0279815cc by (c) Alcoberro, Lídia et al, 2023http://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/2009212026-05-27T06:46:51Z
dc.title.none.fl_str_mv Breaking the 30-day barrier: Long-term effectiveness of a nurse-led 7-step transitional intervention program in heart failure
title Breaking the 30-day barrier: Long-term effectiveness of a nurse-led 7-step transitional intervention program in heart failure
spellingShingle Breaking the 30-day barrier: Long-term effectiveness of a nurse-led 7-step transitional intervention program in heart failure
Alcoberro, Lídia
Insuficiència cardíaca
Ingressos i altes en els hospitals
Heart failure
Hospital admission and discharge
title_short Breaking the 30-day barrier: Long-term effectiveness of a nurse-led 7-step transitional intervention program in heart failure
title_full Breaking the 30-day barrier: Long-term effectiveness of a nurse-led 7-step transitional intervention program in heart failure
title_fullStr Breaking the 30-day barrier: Long-term effectiveness of a nurse-led 7-step transitional intervention program in heart failure
title_full_unstemmed Breaking the 30-day barrier: Long-term effectiveness of a nurse-led 7-step transitional intervention program in heart failure
title_sort Breaking the 30-day barrier: Long-term effectiveness of a nurse-led 7-step transitional intervention program in heart failure
dc.creator.none.fl_str_mv Alcoberro, Lídia
Moliner, Pedro
Vime, Joan
Jiménez Marrero, Santiago
Garay, Alberto
Yun, Sergi
Pons Riverola, Alexandra
Ramos Polo, Raúl
Ras Jiménez, Maria del Mar
Tajes Orduña, Marta
Hidalgo, Encarna
Calero, Esther
Ruiz, Marta
José Bazán, Nuria
Ferre, Carles
Delso, Cristina
Alcober, Laia
Enjuanes, Cristina
Comín Colet, Josep
author Alcoberro, Lídia
author_facet Alcoberro, Lídia
Moliner, Pedro
Vime, Joan
Jiménez Marrero, Santiago
Garay, Alberto
Yun, Sergi
Pons Riverola, Alexandra
Ramos Polo, Raúl
Ras Jiménez, Maria del Mar
Tajes Orduña, Marta
Hidalgo, Encarna
Calero, Esther
Ruiz, Marta
José Bazán, Nuria
Ferre, Carles
Delso, Cristina
Alcober, Laia
Enjuanes, Cristina
Comín Colet, Josep
author_role author
author2 Moliner, Pedro
Vime, Joan
Jiménez Marrero, Santiago
Garay, Alberto
Yun, Sergi
Pons Riverola, Alexandra
Ramos Polo, Raúl
Ras Jiménez, Maria del Mar
Tajes Orduña, Marta
Hidalgo, Encarna
Calero, Esther
Ruiz, Marta
José Bazán, Nuria
Ferre, Carles
Delso, Cristina
Alcober, Laia
Enjuanes, Cristina
Comín Colet, Josep
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Insuficiència cardíaca
Ingressos i altes en els hospitals
Heart failure
Hospital admission and discharge
topic Insuficiència cardíaca
Ingressos i altes en els hospitals
Heart failure
Hospital admission and discharge
description Background and aimsHeart failure (HF) programs successfully reduce 30-day readmissions. However, conflicting data exist about its sustained effects afterwards and its impact on mortality. We evaluated whether the impact of a new nurse-led coordinated transitional HF program extends to longer periods of time, including 90 and 180 days after discharge. Methods and resultsWe designed a natural experiment to undertake a pragmatical evaluation of the implementation of the program. We compared outcomes between patients discharged with HF as primary diagnosis in Period #1 (pre-program; Jan 2017-Aug 2017) and those discharged during Period #2 (HF program; Sept 2017-Jan 2019). Primary endpoint was the composite of all-cause death or all-cause hospitalization 90 and 180 days after discharge. 440 patients were enrolled: 123 in Period #1 and 317 in Period #2. Mean age was 75 +/- 9 years. There were more females in Period #2 (p = 0.025), with no other significant differences between periods. The primary endpoint was significantly reduced in the HF program group, at 90 [adjusted OR 0.31 (0.18-0.53), p <0.001] and at 180 days [adjusted OR 0.18 (CI 0.11-0.32), p <0.001]. Such a decrease was due to a reduction in cardiovascular (CV) and HF hospitalization. All-cause death was reduced when a double check discharge planning was implanted compared to usual care [0 (0%) vs. 7 (3.8%), p = 0.022]. ConclusionA new nurse-led coordinated transitional bundle of interventions model reduces the composite endpoint of all-cause death and all-cause hospitalization both at 90 and 180 days after a discharge for HF, also in high-risk populations. Such a decrease is driven by a reduction of CV and HF hospitalization. Reduction of all-cause mortality was also observed when the full model including a more exhaustive discharge planning process was implemented.
publishDate 2023
dc.date.none.fl_str_mv 2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/200921
url https://hdl.handle.net/2445/200921
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1371/journal.pone.0279815
PLOS ONE, 2023, vol. 18, num. 2
https://doi.org/10.1371/journal.pone.0279815
dc.rights.none.fl_str_mv cc by (c) Alcoberro, Lídia et al, 2023
http://creativecommons.org/licenses/by/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by (c) Alcoberro, Lídia et al, 2023
http://creativecommons.org/licenses/by/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Public Library of Science (PLoS)
publisher.none.fl_str_mv Public Library of Science (PLoS)
dc.source.none.fl_str_mv Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,300719

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