Manejo de la insuficiencia cardíaca en pacientes ancianos a través de la implantación de un hospital de día multidisciplinar

Introduction. To evaluate the utility of a day hospital managed by a multidisciplinary heart failure (HF) team composed of nurses, geriatricians and internal physicians in the reduction of hospital readmission of elderly patients with HF who are not selected by their left ventricular ejection fraction (LVEF). Material and methods. 182 patients with mean age of 76 years and decompensated HP who required admission in internal medicine and geriatric wards were included. A total of 51 patients were followed up in a day hospital, where education, phone access, drug titration and use of parenteral diuretics were performed. Readmission due to HF at 3 months post-hospitalization was measured. A bivariate analysis was performed in both groups using parametrics test (p < 0.05) and a Kaplan Meier analysis using log rank. Results. A total of 61% were women. Mean NYHA class was 2.75 +/- 0.44. LVEF < 45% was found in 40%. Prescription rate of beta blockers was significantly higher in the intervention group (93% vs 24%; p < 0.001) as well as ACE-inhibitors and ARB prescription rates (96% vs 72%, p = 0.002). Readmission rate due to HF in the first 90 days after discharge was lower in the intervention group (11% vs 28%; p = 0.020). HF admission free time was longer for these patient than those managed with conventional care (85.12 days versus 76; log rank; p = 0.026). Discussion. Multidisciplinary intervention carried out by generalist physicians and HF nurses in a day hospital is useful to reduce HF admission in elderly patients not selected by their LVEF.