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Published on: June 10, 2025
Usefulness of a personalized algorithm-based discharge checklist in patients hospitalized for acute heart failure
Florent Allain1, Virginie Loizeau1, Laure Chaufourier2
1Department of Cardiology, Normandie University, UNICAEN, CHU de Caen Normandie, Caen, France.
Insights
A personalized discharge checklist (PCL) for acute heart failure (HF) patients did not significantly reduce mortality or readmissions. However, the PCL improved management of HF comorbidities and referrals to follow-up programs.
Area of Science:
- Cardiology
- Clinical Medicine
- Health Services Research
Background:
- Acute heart failure (HF) hospitalizations are associated with high mortality and readmission rates.
- Effective discharge planning is crucial for improving patient outcomes and quality of care in HF management.
- Personalized interventions may enhance the effectiveness of discharge strategies for HF patients.
Purpose of the Study:
- To evaluate the impact of a personalized discharge checklist (PCL) on mortality, HF readmission, and quality of care in patients hospitalized for acute HF.
- To assess the feasibility and utility of a PCL algorithm based on baseline characteristics and current guidelines.
- To determine if a PCL can improve the management of comorbidities and adherence to follow-up care.
Main Methods:
- A prospective cohort study involving 139 patients hospitalized for acute HF who received a PCL.
- A control group of 182 patients was retrospectively analyzed for comparison.
- The primary endpoint was a composite of mortality or HF readmission at 6 months; secondary endpoints included quality of care metrics.
Main Results:
- No significant difference was observed in the primary endpoint (mortality or HF readmission) between the PCL and control groups (42.4% vs. 50.5%, P=0.15).
- A non-significant trend towards reduced HF readmission was noted in the PCL group (27.3% vs. 35.2%, P=0.13).
- The PCL group showed significantly improved screening and treatment for iron deficiency (53.2% vs. 35.7%) and vitamin D deficiency (73.4% vs. 29.7%), and better referral to HF follow-up programs.
Conclusions:
- The PCL, in this preliminary study, did not significantly improve 6-month mortality or HF readmission rates in acute HF patients.
- The PCL demonstrated significant improvements in managing specific HF comorbidities and facilitating follow-up care referrals.
- Further multicenter studies are warranted to validate the effectiveness and cost-effectiveness of this simple, personalized checklist in a larger HF population.
Aims:
The aim of this study is to evaluate the usefulness of a personalized discharge checklist (PCL) based on simple baseline characteristics on mortality, readmission for heart failure (HF), and quality of care in patients hospitalized for acute HF.
Methods And Results:
We designed an algorithm to generate PCL, based on 2016 HF European Society of Cardiology Guidelines and the screening of common comorbidities in elderly HF patients. We prospectively included 139 patients hospitalized for HF from May 2018 to October 2018. A PCL was fulfilled for each patient at admission and 24 to 48 hours before the planned discharge. A control cohort of 182 consecutive patients was retrospectively included from May 2017 to October 2017. The primary composite endpoint was mortality or readmission for HF at 6 months. The secondary endpoints were mortality, readmission for HF, and quality of care (evidence-based medications, management of HF comorbidities, and planned care plan). There was no difference among baseline characteristics between PCL and control cohorts; mean age was 78.1 ± 12.2 vs. 79.0 ± 12.5 years old (P = 0.46) and 61 patients (43.9%) vs. 63 (34.6%) had HF with left ventricular ejection fraction (LVEF) <40% (P = 0.24). During the 6 month follow-up period, 59 patients (42.4%) reached the primary endpoint in the PCL cohort vs. 92 patients (50.5%) in the control cohort [hazard ratio (HR): 0.79, 95% confidence interval (CI) (0.57-1.09), P = 0.15]. Subgroup analysis including only patients with either altered (<40%) or mid-range or preserved (≥40%) LVEF showed no significant difference among groups. There was a non-significant trend toward a reduction in HF readmission rate in the PCL group [38 patients (27.3%) vs. 64 patients (35.2%), HR: 0.73, 95%CI (0.49-1.09), P = 0.13]. There was no difference regarding survival or the use of evidence-based medications. A higher proportion of patients were screened and treated for iron and vitamin D deficiencies (53.2% vs. 35.7%, P < 0.01 and 73.4% vs. 29.7%, P < 0.01, respectively), as well as malnutrition supplemented in the PCL group. There was a higher referral to HF follow-up programme in the PCL group but not to telemedicine or cardiac rehabilitation programs.
Conclusions:
In this preliminary study, the use of a PCL did not improve outcomes at 6 months in patients hospitalized for acute HF. There was a non-significant trend towards a reduction in HF readmission rate in the PCL group. In addition, the management of HF comorbidities was significantly improved by PCL with a better referral to follow-up programme. A multicentre study is warranted to assess the usefulness of a simple costless personalized checklist in a large HF patients' population.
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