Improving quality of care in patients with decompensated acute heart failure using a discharge checklist.
Aged
Aged, 80 and over
Cardiology Service, Hospital
/ standards
Cause of Death
Checklist
/ standards
Female
Heart Failure
/ diagnosis
Humans
Male
Middle Aged
Patient Discharge
/ standards
Patient Readmission
Quality Improvement
/ standards
Quality Indicators, Health Care
/ standards
Retrospective Studies
Risk Factors
Treatment Outcome
Acute heart failure
Checklist de sortie d’hospitalisation
Discharge checklist
Insuffisance cardiaque aiguë
Journal
Archives of cardiovascular diseases
ISSN: 1875-2128
Titre abrégé: Arch Cardiovasc Dis
Pays: Netherlands
ID NLM: 101465655
Informations de publication
Date de publication:
Historique:
received:
02
12
2018
revised:
22
02
2019
accepted:
21
05
2019
pubmed:
30
7
2019
medline:
28
11
2019
entrez:
30
7
2019
Statut:
ppublish
Résumé
The use of a discharge checklist may decrease heart failure readmission rate. We aimed to evaluate the usefulness of a checklist in patients hospitalized for heart failure, in terms of mortality, cardiovascular mortality and readmission rates, and quality of care, including therapeutic optimization and careplan planning. We prospectively used a discharge checklist in 103 patients hospitalized for heart failure between July 2015 and January 2016. Quality of care and outcomes were compared with a retrospective cohort of 137 patients with same inclusion criteria, hospitalized between June 2014 and December 2014. The primary endpoints were total and cardiovascular mortality and readmissions for heart failure at 6months. The secondary endpoint was quality of care rendered, measured by evidence-based medications, appropriate medication uptitration and planned discharge care. At 6months, there were no differences between the checklist and control cohorts in the rates of all-cause mortality (10.7% vs. 13.1%; P=0.57), cardiovascular mortality (8.7% vs. 10.9%; P=0.58) and readmission (29.1% vs. 32.1%; P=0.62). Follow-up after discharge was better planned in the checklist group. The use of the checklist yielded therapeutic optimization with a higher dose of beta-blockers and renin-angiotensin-aldosterone system blockers, especially in patients with a reduced left ventricular ejection fraction (<50%) (P=0.03 and P=0.02, respectively). The use of a simple discharge checklist in patients with acute heart failure showed no benefit in terms of readmission and mortality rates; however, it yielded better quality of care, including therapeutic optimization and careplan planning.
Sections du résumé
BACKGROUND
BACKGROUND
The use of a discharge checklist may decrease heart failure readmission rate.
AIMS
OBJECTIVE
We aimed to evaluate the usefulness of a checklist in patients hospitalized for heart failure, in terms of mortality, cardiovascular mortality and readmission rates, and quality of care, including therapeutic optimization and careplan planning.
METHODS
METHODS
We prospectively used a discharge checklist in 103 patients hospitalized for heart failure between July 2015 and January 2016. Quality of care and outcomes were compared with a retrospective cohort of 137 patients with same inclusion criteria, hospitalized between June 2014 and December 2014. The primary endpoints were total and cardiovascular mortality and readmissions for heart failure at 6months. The secondary endpoint was quality of care rendered, measured by evidence-based medications, appropriate medication uptitration and planned discharge care.
RESULTS
RESULTS
At 6months, there were no differences between the checklist and control cohorts in the rates of all-cause mortality (10.7% vs. 13.1%; P=0.57), cardiovascular mortality (8.7% vs. 10.9%; P=0.58) and readmission (29.1% vs. 32.1%; P=0.62). Follow-up after discharge was better planned in the checklist group. The use of the checklist yielded therapeutic optimization with a higher dose of beta-blockers and renin-angiotensin-aldosterone system blockers, especially in patients with a reduced left ventricular ejection fraction (<50%) (P=0.03 and P=0.02, respectively).
CONCLUSIONS
CONCLUSIONS
The use of a simple discharge checklist in patients with acute heart failure showed no benefit in terms of readmission and mortality rates; however, it yielded better quality of care, including therapeutic optimization and careplan planning.
Identifiants
pubmed: 31353278
pii: S1875-2136(19)30113-5
doi: 10.1016/j.acvd.2019.05.003
pii:
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
494-501Informations de copyright
Copyright © 2019 Elsevier Masson SAS. All rights reserved.