Planning to reduce 30-day adverse events after discharge of frail elderly patients with acute heart failure: design and rationale for the DEED FRAIL-AHF trial

Objectives: To demonstrate the efficacy of a system for comprehensive care transfer (Multilevel Guided Discharge Plan [MGDP]) for frail older patients diagnosed with acute heart failure (AHF) and to validate the results of MGDP implementation under real clinical conditions. The MGDP seeks to reduce...

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Detalhes bibliográficos
Autores: Martín-Sánchez, Francisco Javier, Llopis García, Guillermo, Llorens, Pere, Jacob, Javier, Herrero, Pablo, Gil, Víctor, Juan i Pastor, Antoni, López-Picado, Amanda, Fuentes Ferrer, Manuel, Rosselló, Xavier, Gil, Pedro, Díez Villanueva, Pablo, Calvo, Elpidio, Mendez Bailon, Manuel, Cuesta-Triana, Federico, González Armengol, Juan Jorge, González del Castillo, Juan, Runtkle, Isabelle, Vidán, Ma. Teresa, Comín Colet, Josep, Cruz Jentoft, Alfonso J., Bueno, Héctor, Miró i Andreu, Òscar, Fernández Pérez, Cristina
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2019
País:España
Recursos:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/185601
Acesso em linha:https://hdl.handle.net/2445/185601
Access Level:acceso abierto
Palavra-chave:Insuficiència cardíaca
Urgències cardiovasculars
Persones grans
Ingressos i altes en els hospitals
Heart failure
Cardiovascular emergencies
Older people
Hospital admission and discharge
Descrição
Resumo:Objectives: To demonstrate the efficacy of a system for comprehensive care transfer (Multilevel Guided Discharge Plan [MGDP]) for frail older patients diagnosed with acute heart failure (AHF) and to validate the results of MGDP implementation under real clinical conditions. The MGDP seeks to reduce the number of adverse outcomes within 30 days of emergency department (ED) discharge. Material and methods: We will enroll frail patients over the age of 70 years discharged home from the ED with a main diagnosis of AHF. The MGDP includes the following components: 1) a checklist of clinical recommendations and resource activations, 2) scheduling of an early follow-up visit, 3) transfer of information to the primary care doctor, and 4) written instructions for the patient. Phase 1 of the study will be a matched-pair cluster-randomized controlled trial. Ten EDs will be randomly assigned to the intervention group and 10 to the control group. Each group will enroll 480 patients, and the outcomes will be compared between groups. Phase 2 will be a quasi-experimental study of the intervention in 300 new patients enrolled by the same 20 EDs. The outcomes will be compared to those for each Phase-1 group. The main endpoint at 30 days will be a composite of 2 outcomes: revisits to an ED and/for hospitalization for AHF or cardiovascular death. Conclusion: The study will assess the efficacy and feasibility of comprehensive MGDP transfer of care for frail older AHF patients discharged home.

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