Care bundle to reduce readmission in patients with heart failure: a modified Delphi consensus panel in Argentina

• Published in: BMJ open Vol. 10; no. 12; p. e040028
• Main Authors: Roberti, Javier, Vita, Tomás, Piastrella, Jimena, Porley, Carlos, Pereyra, Lisandro, Diez, Mirta, Renedo, Florencia, Fairman, Enrique, Fernández, Alberto, Thierer, Jorge, García Elorrio, Ezequiel
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 29.12.2020; BMJ Publishing Group
• Series: Original research
• Subjects: Argentina; Cardiology; Cardiovascular Medicine; Consensus; Delphi Technique; Ejection fraction; Heart failure; Heart Failure - therapy; Hospitals; Humans; Patient Care Bundles; Patient Readmission; Patients; Peptides; Pulmonary arteries; Ultrasonic imaging; Argentina; protocols & guidelines; adult cardiology; heart failure; quality in health care
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-040028

ObjectivesThe aim of this study was to develop consensus among Argentine cardiologists on a care bundle to reduce readmissions of patients with heart failure (HF).SettingHospitals and cardiology clinics in Argentina that provide in-hospital care for patients with HF.ParticipantsTwenty-four cardiology experts participated in the two online rounds and 18 (75%) of them participated in the third-round meeting.MethodsThis 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.ResultsTwenty-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.ConclusionFollowing 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.