Elimination of early rehospitalization in a randomized, controlled trial of multidisciplinary care in a high-risk, elderly heart failure population: the potential contributions of specialist care, clinical stability and optimal angiotensin-converting enzyme inhibitor dose at discharge

Background: Despite a growing body of data demonstrating the benefits of mu ltidisciplinary care in heart failure, persistently high rates of readmissi on, especially within the first month of discharge, continue to be document ed. Aims: As part of an ongoing randomized study on the value of multidisci plinary care in a high risk (NYHA Class IV), elderly (mean age 69 years) he art failure population, we examined the effects of this intervention on pre viously high (20%) 1-month readmission rates. Methods: Unlike previous stud ies of this approach, both multidisciplinary (MC) and routine care (RC) pop ulations were cared for by the cardiology service, complied with adherence to clinical stability criteria prior to discharge (100% of patients) and re ceived at least target dose angiotensin-converting enzyme (ACE) inhibition with perindopril prior to discharge (94% of indicated patients). We analyse d death and unplanned readmission for heart failure at 1 month. Results: Th is early report from the first 70 patients (67% male, 71% systolic dysfunct ion with a mean ejection fraction of 31.0 +/- 6.7%) enrolled in this study demonstrates elimination of 1-month hospital readmission in both RC and MC groups. This unexpected result represents a dramatic improvement both for t his patient cohort (20% 30-day readmission rate prior to enrolment reduced to 0% following the index admission in both care groups) and in comparison with available data. Conclusions: Critical contributors to this improvement appear to be specialist cardiology care, adherence to clinical stability c riteria prior to discharge and routine use of target or high-dose ACE inhib itor therapy prior to discharge. Widespread application of this approach ma y have a dramatic improvement in morbidity of CHF while limiting the escala ting costs of this condition. (C) 2001 European Society of Cardiology. All rights reserved.