Impact of age in the effectiveness of the implementation of a transitional-care heart failure program: a population-based analysis with real-world data in 77,554 patients

Background Old age has a negative impact in terms of outcomes and medical resource use in patients with heart failure (HF). The efficacy of HF management programs has been widely proved, however the influence of age in the effectiveness of HF programs is still unknown. Purpose To analyze the effect of age on health outcomes before and after a pragmatic implementation of an intensive transitional care nurse-based HF management program integrating hospital and primary care and resources for patients with HF at a high risk of events in a health-care area of 209,255 inhabitants. Methods For the purposes of this study, we included all individuals consecutively admitted to hospital with at least one ICD-9-CM code for HF as the primary diagnosis and discharged alive in Catalonia between January, the 1st, 2015 and December, the 31st of 2019. We considered 3 distinct periods of implementation of the HF program: pre-implementation (2015-2016), transition (2017) and consolidation (2018-2019). To evaluate the efficacy of the program according to age strata, we compared outcomes between HF patients of the implementation area and HF patients of the remaining healthcare areas of Catalonia across implementation periods and stratified according to age strata. Results We included 77,554 patients in the study: 3,396 in the implementation area (HUB-Delta area) and 74,158 in the rest of Catalonia. According to age, patients were classified as, 15-74 years age-group (19.624, 25.3%), 75-84 years age-group (28.054, 36.1%) and >84 years age-group (29.876, 38.5%). In the implementation area, all-cause death, clinically related hospitalizations and HF readmissions were significantly improved in the consolidation period compared to the pre-implementation period in all age-groups (Table 1). As shown in Figure 1, left column, the implementation of the program resulted in a significant improvement in all outcomes evaluated for the whole HF population of the HUB-Delta area compared to the rest of Catalonia. The improvement was consistent across all age groups (Figure 1, middle and right columns) in the consolidation period for all outcomes evaluated. However, in patients >84 years old, the size effect of improvement in patients of the HUB-Delta area tended to be attenuated when compared to the benchmark. Conclusions The risk of mortality, clinically related hospitalizations and HF hospitalizations in recently discharged patients with HF has an independent association with age. The implementation of an intensive transitional care nurse-based HF management program improves clinical outcomes across age strata. Remarkably these improvements are also seen in very old patients above 84 years old.