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

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

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.