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  • Poster presentation
  • Open Access

Decrease in the 30-day heart failure (HF) Rehospitalization Rate after the implementation of a HF managed protocol

  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Critical Care200913 (Suppl 3) :P7

https://doi.org/10.1186/cc7809

  • Published:

Keywords

  • Heart Failure
  • Smoking Cessation
  • Quality Indicator
  • Cardiogenic Shock
  • Angiotensin Receptor Blocker

Introduction

Heart failure (HF) is associated with high morbidity and mortality rates, including frequent rehospitalization. The 30-day HF Rehospitalization Rate is an outcome quality indicator used to measure the quality of care.

Objective

To identify changes in the 30-day HF Rehospitalization Rate after the implementation of a HF managed protocol.

Methods

A cross-sectional prospective study of 671 patients hospitalized for heart failure in a tertiary private Brazilian hospital. Patients were divided into two groups: 189 patients admitted in the pre-protocol period (January 2005 to July 2006) and 452 patients admitted in the post-protocol period (August 2006 to May 2008). Mean age was 75.0 ± 12.0 years (range: 21 to 102 years). The HF protocol was implemented on 1 August 2006 and consisted of a written protocol, on-time data collection for quality indicators, and periodic performance feedback (reports) given to the clinical and administrative staff. Data collection before the protocol implementation was done retrospectively by a nurse case-manager. Statistical analysis was performed using the chi-square test, Student's t test and Fisher's exact test. P < 0.05 was considered statistically significant.

Results

There was a significant decrease in the 30-day HF Rehospitalization Rate after, along with an increase in β-blocker, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) and smoking cessation counseling rates (Table 1).
Table 1

(abstract P7)

Variable

Pre-protocol

Post-protocol

P value

Age (years), mean ± SD

76.9 ± 10.2

75.0 ± 12.0

0.27

Ejection fraction (%), mean ± SD

31.0 ± 7.67

31.9 ± 7.6

1

Admitted in cardiogenic shock (%)

19.0

37.1

0.000002

β-Blocker use (%)

53.4

67.5

0.002

ACEI/ARB use (%)

79.8

87.8

0.06

Spironolactone use (%)

29.4

47.7

0.126

Smoking cessation counseling rate (%)

5.9

62.9

0.00008

30-day HF Rehospitalization Rate

31/189 (16.40%)

33/452 (7.30%)

0.0008

Conclusion

In the present study, the implementation of a HF managed protocol led to a significant decrease in the 30-day HF Rehospitalization Rate along with an increase in the prescription rate of evidence-based therapies, even though the rate of patients admitted in cardiogenic shock was higher.

Authors’ Affiliations

(1)
Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

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