Volume 19 Supplement 2

Eighth International Symposium on Intensive Care and Emergency Medicine for Latin America

Open Access

Implementation and certification of a heart failure clinical care program in a middle income country: impact in clinical outcomes after 2 years

  • Pedro Gabriel MB Silva1,
  • Antonio Baruzzi1,
  • Douglas Ribeiro1,
  • Flavio Brito1,
  • Giuliano Generoso1,
  • Jose Teixeira1,
  • Marcelo Jamus1,
  • Mariana Okada1,
  • Thiago Macedo1 and
  • Valter Furlan1
Critical Care201519(Suppl 2):P8

https://doi.org/10.1186/cc14664

Published: 28 September 2015

Introduction

Clinical care programs (CCP) that monitor and optimize care have the potential to improve outcomes; however, their real benefits are still controversial.

Objective

This study aims to evaluate the hypothesis of benefits in clinical outcomes after 2 years of a CCP.

Methods

Prospective study of consecutive patients hospitalized with HF in a Brazilian private cardiovascular center. Two groups were compared based on the time to CCP initiation: the historical group, compounded by patients from the 6 months prior to CCP (group 1); and the intervention group, compounded by patients admitted with diagnosis of HF from July 2012 until June 2014, the period when patients and staff were monitored on a daily basis by a case manager nurse and a medical leader which provided educational interventions. The CCP was certified by an international society in October 2012.

Results

In a total of 2188 patients, the mean age was 69.3 years and 55.8% were male (Table 1). Evidence-based therapies at hospital discharge (ACEI/ARB and beta-blocker in eligible patients) showed no significant change (95.8% pre-CCP and 97.5% post-CCP; p = 0.12). The outcomes analyzed in groups 1 and 2, were, respectively: hospital readmissions due to HF within 30 days (13.9% vs. 9.1%; p = 0.008); length of stay (8.9 ± 7.9 days vs. 7.9 ± 5.6 days, p = 0.01); decompensation of HF by poor adherence (16.8% vs. 10.5%; p = 0.001); and in-hospital mortality (9% vs. 6.9%; p = 0.24).

Table 1

 

Pre-CCP (historical group)

CCP (intervention group)

Number of patients

338

1850

Mean age

71 (±13.5)

69 (±11.2)

Male (%)

55% (95% CI: 50-60%)

56% (95% CI: 54-58%)

Mean EF (%)

37% (±13.3)

42% (±11.1)

Hemodynamic profile C (%)

5.65% (CI95%: 3-8%)

4.2% (95% CI: 3.4-5.2%)

Ischemic cardiopathy (%)

48.2% (CI95%: 43-53.5%)

58% (95% CI: 56-60%)

HFpEF (%)

37% (CI95%: 32-42%)

27% (95% CI: 25-29%)

Cardiorenal syndrome (%)

35% (CI95%: 30-40%)

33% (95% CI: 31-35%)

Infection (%)

23% (95% CI: 19-28%)

22% (95% CI: 20-24%)

Conclusion

During the 2 years of the CCP there was a reduction of 1 day in the length of stay, and a lower frequency of hospitalizations by poor treatment adherence, and in readmissions in 30 days.

Authors’ Affiliations

(1)
Hospital Totalcor, Cerqueira Cesar, São Paulo

Copyright

© MB Silva et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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