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Titolo:
Elimination of early rehospitalization in a randomized, controlled trial of multidisciplinary care in a high-risk, elderly heart failure population: the potential contributions of specialist care, clinical stability and optimal angiotensin-converting enzyme inhibitor dose at discharge
Autore:
McDonald, K; Ledwidge, M; Cahill, J; Kelly, J; Quigley, P; Maurer, B; Begley, F; Ryder, M; Travers, B; Timmons, L; Burke, T;
Indirizzi:
St Vincents Univ Hosp, Cardiomyopathy Res Grp, Dublin 4, Ireland St Vincents Univ Hosp Dublin Ireland 4 opathy Res Grp, Dublin 4, Ireland Council Heart Failure, Irish Heart Fdn, Dublin, Ireland Council Heart Failure Dublin Ireland , Irish Heart Fdn, Dublin, Ireland Servier Labs, Dublin, Ireland Servier Labs Dublin IrelandServier Labs, Dublin, Ireland
Titolo Testata:
EUROPEAN JOURNAL OF HEART FAILURE
fascicolo: 2, volume: 3, anno: 2001,
pagine: 209 - 215
SICI:
1388-9842(200103)3:2<209:EOERIA>2.0.ZU;2-R
Fonte:
ISI
Lingua:
ENG
Soggetto:
HOSPITAL READMISSION; RESOURCE UTILIZATION; MANAGEMENT; INTERVENTION; PROGRAM; IMPACT;
Keywords:
heart failure; multidisciplinary care; early readmission; discharge stability; angiotensin-converting enzyme inhibitor;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
26
Recensione:
Indirizzi per estratti:
Indirizzo: McDonald, K St Vincents Univ Hosp, Cardiomyopathy Res Grp, Elm Pk, Dublin 4, Ireland St Vincents Univ Hosp Elm Pk Dublin Ireland 4 blin 4, Ireland
Citazione:
K. McDonald et al., "Elimination of early rehospitalization in a randomized, controlled trial of multidisciplinary care in a high-risk, elderly heart failure population: the potential contributions of specialist care, clinical stability and optimal angiotensin-converting enzyme inhibitor dose at discharge", EUR J HE FA, 3(2), 2001, pp. 209-215

Abstract

Background: Despite a growing body of data demonstrating the benefits of multidisciplinary care in heart failure, persistently high rates of readmission, especially within the first month of discharge, continue to be documented. Aims: As part of an ongoing randomized study on the value of multidisciplinary care in a high risk (NYHA Class IV), elderly (mean age 69 years) heart failure population, we examined the effects of this intervention on previously high (20%) 1-month readmission rates. Methods: Unlike previous studies of this approach, both multidisciplinary (MC) and routine care (RC) populations were cared for by the cardiology service, complied with adherenceto clinical stability criteria prior to discharge (100% of patients) and received at least target dose angiotensin-converting enzyme (ACE) inhibitionwith perindopril prior to discharge (94% of indicated patients). We analysed death and unplanned readmission for heart failure at 1 month. Results: This early report from the first 70 patients (67% male, 71% systolic dysfunction with a mean ejection fraction of 31.0 +/- 6.7%) enrolled in this studydemonstrates elimination of 1-month hospital readmission in both RC and MCgroups. This unexpected result represents a dramatic improvement both for this patient cohort (20% 30-day readmission rate prior to enrolment reducedto 0% following the index admission in both care groups) and in comparisonwith available data. Conclusions: Critical contributors to this improvement appear to be specialist cardiology care, adherence to clinical stability criteria prior to discharge and routine use of target or high-dose ACE inhibitor therapy prior to discharge. Widespread application of this approach may have a dramatic improvement in morbidity of CHF while limiting the escalating costs of this condition. (C) 2001 European Society of Cardiology. Allrights reserved.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 02/04/20 alle ore 12:36:43