Impact of heart failure management unit on heart failure-related readmission rate and mortality

Background. - Heart failure is the leading cause of hospital admissions and an economic burden. In accordance with European guidelines, a dedicated heart failure unit was created in Rene Dubos Hospital (Pontoise, France) in 2002. Aim. - To evaluate the impact of an in-hospital heart failure management unit on heart failure prognosis. Methods. - We conducted a descriptive study of all-cause in-hospital mortality and heart failure related readmission rates in the year after the first admission for heart failure, from January 1997 to December 2007. The Chi(2) test, a trend test and linear regression were performed. Results. - There were no significant differences in patient characteristics (age, sex, diabetes mellitus, left ventricular ejection fraction <45%) other than renal insufficiency, in patients admitted for heart failure from 1997 to 2007. After the creation of the heart failure unit, we observed a significant decrease in heart failure related readmission rate from 21.7% in 2002 to 15.6% in 2007 (p < 0.0001), whereas there was no difference in this rate before the creation of the unit (34.3% in 1997 and in 2001; p = 0.90). All-cause in-hospital mortality rate decreased from 9.3% in 1997 to 5.1% in 2007 (p < 0.0001) and showed a tendency to decrease after the creation of the heart failure unit (p = 0.06). Conclusion. - Heart failure related readmission rates in new patients in the year after the first admission for heart failure reduced dramatically after the creation of the heart failure unit. All-cause in-hospital mortality in heart failure patients decreased over the 10-year study period. (C) 2010 Elsevier Masson SAS. All rights reserved.