A Triage clinic providing early post-discharge follow-up reduced recurrent admissions for heart failure or all causes by 75% at 1 month and 60% at 3 to 12 months compared to a control group.
Cohort
No
Does an early post-discharge Triage clinic reduce readmissions in patients recently hospitalized for heart failure?
A dedicated post-discharge heart failure triage clinic significantly reduces both heart failure and all-cause readmissions compared to standard care.
Estimación del efecto: 75% reduction at 1 month, 60% reduction at 3-12 months
Abstract Background Heart Failure (HF) causes an immense medical and financial burden on health systems. Recurrent hospitalizations lead to a severe reduction in quality of life and worsen prognosis. The chance of readmission is 24% within a month after discharge and over 50% within 6 months, despite great improvements in treatment. A large proportion of readmissions are for noncardiac reasons. Aim To reduce readmissions in patients recently discharged from a hospitalization for HF worsening, by improving and promoting close communication between hospital and community. Methods We initiated a pilot study at our community HF unit (HFU), whereby details of patients hospitalized for HF on two general medical wards were sent directly by the ward nursing staff to the HFU head nurse, and the patients were invited to the HFU as soon as possible after discharge (the Triage clinic). The treatment protocol included IV therapy where indicated (furosemide, iron) and titration of oral medications, with close medical and laboratory follow-up. Readmissions rates over 1, 3, 6 & 12 months (for HF or all causes, including HF) were compared to the equivalent period prior to the index admission. A further comparison was made with a control group of HF patients invited to the HFU but who chose not to attend. Results Between 2/2020 and 3/2021, 108 patients were seen in the Triage clinic, within an average time of 11 days from discharge. After the first visit, 10 patients were discharged and 1 died. 97, 75 & 46 patients completed follow-up of 3, 6 & 12 months, respectively. Readmissions for HF were 50% lower over 1,3, & 6 months compared to the equivalent period before treatment in the Triage clinic, and 15% lower after 12 months. Readmissions for all causes were 45% lower over 1, 3 & 6 months compared to the equivalent period before treatment in the Triage clinic, and 35% lower after 12 months. In the control group, 55, 33 and 15 patients completed follow-up of 3, 6 & 12 months, respectively. On comparing the Triage group to the control group, there was a reduction of 75% in recurrent admissions for HF or all causes after 1 month, and 60% reduction after 3, 6 and 12 months. In the Triage group, there were an average 2.5 changes in therapy per patient per month. On average, there was an average 1.6 IV furosemide and 2.6 IV iron treatments per patient per year. The functional capacity improved by a factor of 2.5. Conclusions Promoting close communication between hospital and community can lead to a significant improvement in HF care, as seen by better quality and efficacy of therapy and speed of access. This in turn reduces rehospitalizations and improves quality of life.
Weinstein et al. (Wed,) conducted a cohort in Heart Failure. Triage clinic (early post-discharge follow-up and hospital-community communication) vs. Historical period prior to index admission and a control group of non-attending patients was evaluated on Readmissions for heart failure or all causes (75% reduction at 1 month, 60% reduction at 3-12 months). A Triage clinic providing early post-discharge follow-up reduced recurrent admissions for heart failure or all causes by 75% at 1 month and 60% at 3 to 12 months compared to a control group.