scholarly journals Early and comprehensive care bundle in elderly for acute heart failure in the emergency department: study protocol of The ELISABETH stepped wedge cluster randomized trial

2018 ◽  
Author(s):  
Yonathan Freund ◽  
Judith Gorlick ◽  
Marine Cachanado ◽  
Sarah Salhi ◽  
Vanessa Lemaitre ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Elderly Patients ◽  
Acute Heart Failure ◽  
Control Period ◽  
Care Bundle ◽  
Stepped Wedge ◽  
Precipitating Factors ◽  
Intervention Period ◽  
Cluster Randomized

Abstract Background: Acute heart failure (AHF) is one of the most common diagnoses for elderly patients in the emergency department (ED), with an admission rate higher than 80% and 1-month mortality around 10%. The European guidelines for the management of AHF are based on moderate levels of evidence, due to the lack of randomized controlled trials and the scarce evidence of any clinical added value of a specific treatment to improve outcomes. Recent reports suggest that the very early administration of full recommended therapy may decrease mortality. However, several studies highlighted that elderly patients often received suboptimal treatment. Our hypothesis is that an early care bundle that comprises early and comprehensive management of symptoms, along with prompt detection and treatment of precipitating factors should improve AHF outcome in elderly patients. Method/design: ELISABETH is a stepped-wedge, controlled cluster randomized, clinical trial in 15 emergency departments in France recruiting all patients aged 75 years and older with a diagnosis of AHF. The tested intervention is a care bundle with a checklist that mandates detection and early treatment of AHF precipitating factors, early and intensive treatment of congestion with intravenous nitrates boluses, and application of other recommended treatment (low dose diuretics, non-invasive ventilation when indicated, and preventive low molecular weight heparin). Each centre are randomized to the order in which they will switch from “control period” to “intervention period”. All centers begin the trials with the control period for two weeks, then after each two-weeks step a new centre will be in the intervention period. At the end of the trial, all clusters will receive the intervention regimen. The primary outcome is the number of days alive and out of the hospital at 30 days. Discussion: If our hypothesis is confirmed, this trial will strengthen the level of evidence of AHF guidelines and stress the importance of the associated early and comprehensive treatment of precipitating factors. This trial could be the first to report a reduction in short term morbidity and mortality in elderly AHF patients. Registration: NCT03683212, prospectively registered on September 25th 2018 Keywords: Elderly, acute heart failure, emergency department

scholarly journals Effect of an Emergency Department Care Bundle on 30-Day Hospital Discharge and Survival Among Elderly Patients With Acute Heart Failure

JAMA ◽  
2020 ◽  
Vol 324 (19) ◽  
pp. 1948
Author(s):  
Yonathan Freund ◽  
Marine Cachanado ◽  
Quentin Delannoy ◽  
Said Laribi ◽  
Youri Yordanov ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Elderly Patients ◽  
Hospital Discharge ◽  
Acute Heart Failure ◽  
Care Bundle ◽  
Day Hospital ◽  
Emergency Department Care

scholarly journals LO14: Interdepartmental program to improve outcomes for acute heart failure patients seen in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S11-S12
Author(s):  
I. Stiell ◽  
M. Taljaard ◽  
A. Forster ◽  
L. Mielniczuk ◽  
G. Wells ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
Control Period ◽  
Care Hospital ◽  
Index Visit ◽  
Rapid Access

Introduction: An important challenge physicians face when treating acute heart failure (AHF) patients in the emergency department (ED) is deciding whether to admit or discharge, with or without early follow-up. The overall goal of our project was to improve care for AHF patients seen in the ED while avoiding unnecessary hospital admissions. The specific goal was to introduce hospital rapid referral clinics to ensure AHF patients were seen within 7 days of ED discharge. Methods: This prospective before-after study was conducted at two campuses of a large tertiary care hospital, including the EDs and specialty outpatient clinics. We enrolled AHF patients ≥50 years who presented to the ED with shortness of breath (<7 days). The 12-month before (control) period was separated from the 12-month after (intervention) period by a 3-month implementation period. Implementation included creation of rapid access AHF clinics staffed by cardiology and internal medicine, and development of referral procedures. There was extensive in-servicing of all ED staff. The primary outcome measure was hospital admission at the index visit or within 30 days. Secondary outcomes included mortality and actual access to rapid follow-up. We used segmented autoregression analysis of the monthly proportions to determine whether there was a change in admissions coinciding with the introduction of the intervention and estimated a sample size of 700 patients. Results: The patients in the before period (N = 355) and the after period (N = 374) were similar for age (77.8 vs. 78.1 years), arrival by ambulance (48.7% vs 51.1%), comorbidities, current medications, and need for non-invasive ventilation (10.4% vs. 6.7%). Comparing the before to the after periods, we observed a decrease in hospital admissions on index visit (from 57.7% to 42.0%; P <0.01), as well as all admissions within 30 days (from 65.1% to 53.5% (P < 0.01). The autoregression analysis, however, demonstrated a pre-existing trend to fewer admissions and could not attribute this to the intervention (P = 0.91). Attendance at a specialty clinic, amongst those discharged increased from 17.8% to 42.1% (P < 0.01) and the median days to clinic decreased from 13 to 6 days (P < 0.01). 30-day mortality did not change (4.5% vs. 4.0%; P = 0.76). Conclusion: Implementation of rapid-access dedicated AHF clinics led to considerably increased access to specialist care, much reduced follow-up times, and possible reduction in hospital admissions. Widespread use of this approach can improve AHF care in Canada.

scholarly journals Screening by Social Workers in Medical Patients with Risk of Post-Acute Care Needs: A Stepped Wedge Cluster Randomized Trial / Evaluation eines Screenings durch Sozialarbeiter bei medizinischen Patienten mit einem Risiko für post-akuten Nachsorgebedarf: eine stepped wedge clusterrandomisierte Studie

2018 ◽  
Vol 5 (1) ◽  
pp. 25-34
Author(s):  
Antoinette Conca ◽  
Doaa Ebrahim ◽  
Sandra Noack ◽  
Angela Gabele ◽  
Helen Weber ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Social Workers ◽  
Acute Care ◽  
Discharge Planning ◽  
Control Period ◽  
Stepped Wedge ◽  
Intervention Period ◽  
Care Needs ◽  
Cluster Randomized ◽  
Post Acute Care

AbstractBackgroundElderly patients often need post-acute care after hospital discharge. Involvement of social workers can positively affect the discharge planning process.AimTo investigate the effect of screening patients at risk for post-acute care needs by social workers on time with respect to social workers’ notification, length of stay and delays in discharge compared to usual care.MethodsCluster randomized stepped wedge trial design for five clusters (wards) and two steps (control to intervention) was used. A total of 400 patients (200 per period) with high risk of post-acute care needs (defined as Post-Acute Care Discharge score, PACD ≥ 7) were included. Social workers performed a screening to decide about self-referral to their services (intervention period), which was compared to a highly structured standard SW notification by physicians and nurses (control period). A Generalized Estimating Equations model adjusted the clustering and baseline differences.ResultsA total of 139 patients were referred to social services (intervention: n = 76; control: n = 63). Time to social workers’ notification was significantly shorter in the intervention period when adjusted for all the differences in baseline (Mdn 1.2 vs 1.7, Beta = -0.73, 95%-CI 1.39 to -0.09). Both the length of stay and the delayed discharge time in nights showed no significant differences (Mdn 10.0 vs 9.1, Beta = -0.12, 95%-CI 0.46 to .22 nights 95%-CI, resp. Mdn 0.0 vs 0.0, Beta = .11, 95%-CI -0.64 to 0.86).ConclusionScreening speeded up social workers’ notification but did not accelerate the discharge processes. The screening by social workers might show process improvement in settings with less structured discharge planning.

scholarly journals Good Performance in the Management of Acute Heart Failure in Cardiogeriatric Departments : The ICREX-94 Experience

2021 ◽  
Author(s):  
Emmanuelle Berthelot ◽  
Amaury Broussier ◽  
Thibaud Damy ◽  
Cristiano Donadio ◽  
Stephane Cosson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Observational Study ◽  
Elderly Patients ◽  
Human Development ◽  
Acute Heart Failure ◽  
Human Development Index ◽  
Independent Living ◽  
Neurocognitive Disorder ◽  
Precipitating Factors ◽  
Development Index

Abstract Context: A growing number of elderly patients hospitalized for Acute Heart Failure (AHF) are being managed in cardiogeriatrics departments, but their characteristics and prognosis are poorly known. This study aimed to investigate the profile and outcome (rehospitalization at 90 days) of patients hospitalized for AHF in cardiogeriatrics departments in the Val-de-Marne area in the suburbs of Paris, and to compare them to AHF patients hospitalized in cardiology departments in the same area. Methods: Observational study, ICREX-94, conducted in seven cardiology departments in France and three specific cardiogeriatrics departments in Val-de-Marne. Results: A total of 308 patients were hospitalized for AHF between October 2017 and January 2019. During the 90 days following discharge, 29.6% patients were readmitted to the hospital. Compared with patients hospitalized in cardiology departments, patients in cardiogeriatrics departments were older (p<0.001), less independent (living more often alone or in an institution) (p<0.001), more often depressed (p<0.001), had more often major neurocognitive disorder (p<0.001), had a higher Human Development Index (HDI, p<0.001), and were less often diagnosed with amyloidosis (p<0.001). There was no difference in outcome whether patients were discharged from cardiology or cardiogeriatrics departments. The most frequent precipitating factors underlying AHF decompensation between the first and second hospitalization were arrhythmia and infection.Conclusion: AHF patients discharged from cardiogeriatrics departments, compared to cardiology departments, showed clinical differences but had the same prognosis regarding AHF rehospitalization at 90 days.

Acute heart failure in the emergency department: Short and long-term outcomes of elderly patients with heart failure

2008 ◽  
Vol 10 (3) ◽  
pp. 308-314 ◽  
Author(s):  
Justin A. Ezekowitz ◽  
Jeffery A. Bakal ◽  
Padma Kaul ◽  
Cynthia M. Westerhout ◽  
Paul W. Armstrong
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Elderly Patients ◽  
Acute Heart Failure ◽  
Long Term Outcomes ◽  
Patients With Heart Failure ◽  
Short And Long Term

scholarly journals Good performance in the management of acute heart failure in cardiogeriatric departments: the ICREX-94 experience

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emmanuelle Berthelot ◽  
◽  
Amaury Broussier ◽  
Thibaud Damy ◽  
Cristiano Donadio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Observational Study ◽  
Elderly Patients ◽  
Human Development ◽  
Acute Heart Failure ◽  
Human Development Index ◽  
Independent Living ◽  
Neurocognitive Disorder ◽  
Precipitating Factors ◽  
Development Index

Abstract Context A growing number of elderly patients hospitalized for Acute Heart Failure (AHF) are being managed in cardiogeriatrics departments, but their characteristics and prognosis are poorly known. This study aimed to investigate the profile and outcome (rehospitalization at 90 days) of patients hospitalized for AHF in cardiogeriatrics departments in the Val-de-Marne area in the suburbs of Paris, and to compare them to AHF patients hospitalized in cardiology departments in the same area. Methods Observational study, ICREX-94, conducted in seven cardiology departments in France and three specific cardiogeriatrics departments in Val-de-Marne. Results A total of 308 patients were hospitalized for AHF between October 2017 and January 2019. During the 90 days following discharge, 29.6% patients were readmitted to the hospital. Compared with patients hospitalized in cardiology departments, patients in cardiogeriatrics departments were older (p < 0.001), less independent (living more often alone or in an institution) (p < 0.001), more often depressed (p < 0.001), had more often major neurocognitive disorder (p < 0.001), had a higher Human Development Index (HDI, p < 0.001), and were less often diagnosed with amyloidosis (p < 0.001). There was no difference in outcome whether patients were discharged from cardiology or cardiogeriatrics departments. The most frequent precipitating factors underlying AHF decompensation between the first and second hospitalization were arrhythmia and infection. Conclusion AHF patients discharged from cardiogeriatrics departments, compared to cardiology departments, showed clinical differences but had the same prognosis regarding AHF rehospitalization at 90 days.

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