Care bundle to reduce readmission in patients with heart failure: a modified Delphi consensus panel in Argentina. Issue 12 (29th December 2020)

• Record Type: Journal Article
• Authors: Roberti, Javier; Vita, Tomás; Piastrella, Jimena; Porley, Carlos; Pereyra, Lisandro; Diez, Mirta; Renedo, Florencia; Fairman, Enrique; Fernández, Alberto; Thierer, Jorge; García Elorrio, Ezequiel
• Is Part Of: BMJ open. Volume 10:Issue 12(2020)
• Publication Date: 2020-12-29
• Subjects: adult cardiology -- heart failure -- quality in health care -- protocols & guidelines; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2020-040028
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: The aim of this study was to develop consensus among Argentine cardiologists on a care bundle to reduce readmissions of patients with heart failure (HF). Setting: Hospitals and cardiology clinics in Argentina that provide in-hospital care for patients with HF. Participants: Twenty-four cardiology experts participated in the two online rounds and 18 (75%) of them participated in the third-round meeting. Methods: This study used a mixed-method design; it was conducted between August 2019 and January 2020. The development of a care bundle (a set of evidence-based interventions applied to improve clinical outcomes) involved three phases: (1) a literature review to define the list of interventions to be evaluated; (2) a modified Delphi panel to select interventions for the bundle and (3) definition of the HF care bundle. Also, the process included three rounds of scoring. Results: Twenty-six interventions were evaluated. The interventions in the final bundle covered four categories: medication, continuum of care, lifestyle habits, predischarge tests. These were: medication: beta-blockers, angiotensin receptor neprilysin inhibitors or ACE-inhibitors, furosemide and antimineralocorticoids; continuum of care: follow-up appointment, daily weight monitoring; lifestyle habits: smoking cessation counselling and low-sodium diet; predischarge tests: renal function, ionogram, blood pressure control, echocardiogram and determination of decompensating cause. Conclusion: Following a systematic mixed-method approach, we have developed a care bundle of interventions that could decrease readmission of patients with HF. The application of this bundle could contribute to scale evidence-based interventions.