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

Abstract

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. Method: 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 casemanager. 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 presented) Conclusions: 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.