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Rev Esp Cardiol (Engl Ed). 2014 Apr;67(4):283-93. doi: 10.1016/j.rec.2013.12.005. Epub 2014 Feb 8.

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

Author information

1
Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain. Electronic address: josepcomin@gmail.com.
2
Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Atención Primaria Sant Martí de Provençals, Institut Català de la Salut, Barcelona, Spain; Institut d'Investigació d'Atenció Primària Jordi Gol, Institut Català de la Salut, Barcelona, Spain.
3
División de Análisis de la Demanda y la Actividad, Servei Català de la Salut, Barcelona, Spain.
4
Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain; Centro de Atención Primaria Poble Nou, Institut Català de la Salut, Barcelona, Spain.
5
Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain.
6
Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain.
7
Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain.

Abstract

INTRODUCTION AND OBJECTIVES:

The efficacy of heart failure programs has been demonstrated in clinical trials but their applicability in the real world practice setting is more controversial. This study evaluates the feasibility and efficacy of an integrated hospital-primary care program for the management of patients with heart failure in an integrated health area covering a population of 309,345.

METHODS:

For the analysis, we included all patients consecutively admitted with heart failure as the principal diagnosis who had been discharged alive from all of the hospitals in Catalonia, Spain, from 2005 to 2011, the period when the program was implemented, and compared mortality and readmissions among patients exposed to the program with the rates in the patients of all the remaining integrated health areas of the Servei Català de la Salut (Catalan Health Service).

RESULTS:

We included 56,742 patients in the study. There were 181,204 hospital admissions and 30,712 deaths during the study period. In the adjusted analyses, when compared to the 54,659 patients from the other health areas, the 2083 patients exposed to the program had a lower risk of death (hazard ratio=0.92 [95% confidence interval, 0.86-0.97]; P=.005), a lower risk of clinically-related readmission (hazard ratio=0.71 [95% confidence interval, 0.66-0.76]; P<.001), and a lower risk of readmission for heart failure (hazard ratio=0.86 [95% confidence interval, 0.80-0.94]; P<.001). The positive impact on the morbidity and mortality rates was more marked once the program had become well established.

CONCLUSIONS:

The implementation of multidisciplinary heart failure management programs that integrate the hospital and the community is feasible and is associated with a significant reduction in patient morbidity and mortality.

KEYWORDS:

Chronic care model; Disease management programs; Experimento natural; Health outcomes; Heart failure; Insuficiencia cardiaca; Modelo de atención a la cronicidad; Natural experiment; Programas de gestión de enfermedades; Resultados en salud

PMID:
24774591
DOI:
10.1016/j.rec.2013.12.005
[Indexed for MEDLINE]

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