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Published on: April 19, 2019
[Home return Assistance Program for Chronic heart failure in-hospitalized patients (PRADO-IC) : Description,
1Service de Cardiologie, Groupe hospitalier Paris Saint Joseph, 185 rue Raymond Losserand 75014 Paris, France.
Insights
The PRADO-IC program supports patients after hospital discharge for congestive heart failure (CHF). Initial evaluations suggest benefits, but clinical studies show no significant improvement in mortality or re-hospitalization rates for CHF patients.
Area of Science:
- Cardiology
- Public Health
- Healthcare Management
Context:
- Congestive heart failure (CHF) readmissions pose significant challenges.
- The PRADO-IC program was established in France to manage post-discharge care for CHF patients.
- Optimizing transitional care is crucial for improving patient outcomes and reducing healthcare costs.
Purpose:
- To describe the PRADO-IC program.
- To present epidemiological data and evaluations of the program.
- To analyze the strengths, limitations, and future perspectives of CHF transitional care.
Summary:
- The PRADO-IC program involves a three-month multidisciplinary approach managed by a CPAM advisor, GP, and a trained nurse.
- Retrospective analyses by CNAM indicated improved follow-up and reduced 6-month mortality.
- However, clinical studies did not confirm these benefits, showing similar mortality and re-hospitalization rates compared to controls.
Impact:
- PRADO-IC is the sole national transitional care program for heart failure patients in France.
- Despite initial positive evaluations, prospective studies are needed to validate its effectiveness and address methodological biases.
- Identified limitations include a lack of clear inclusion criteria, insufficient geriatric assessment, and a short program duration.
Introduction:
Return to home after discharge for congestive heart failure (CHF) is associated with prolonged and recurrent hospitalizations, the prognosis remains poor. Since 2013, the Caisse Nationale d'Assurance Maladie (CNAM) with the Société Française de Cardiologie (SFC) has set up a support program PRADO-IC (support program for returning home after hospitalization for heart failure).
The Aim Of This Study:
was to describe the program, to present epidemiologic data, and the evaluations by the CNAM, and by clinical studies, then to expose strengths limits and perspectives.
Results:
After the inclusion a CPAM advisor organize the outcome, the care of the outpatient is based on his general practitioner (GP) and a private nurse trained in CHF care during a three-months program. Between 2017 and 2019, 20 264 patients per year were hospitalized in Ile de France, 8.8% were included in PRADO-IC. The retrospective CNAM evaluations were positive: follow up criteria were improved and mortality rate at 6 months was lower (10.3% vs. 14.1%). However, clinical retrospective study of Troyes hospital (n = 89), and Paris Saint Joseph Hospital (n = 633), did not confirm these results: rate mortality and/or re-hospitalization were not different between patients and control. Several prospective studies are underway; results will be soon available. Limits of PRADO-IC are discussed like the lack of inclusion criteria, lack of geriatric evaluation, or the pivotal role based on GP, and the short term of duration. Strengths are its existence, national reach, multi-disciplinary approach, educational contents. Clinical studies showed that the PRADO-IC program concerned to the most severe patients. Despite this, the one-year mortality and the HF readmission rate are the same than out-program patients.
Conclusion:
PRADO-IC is the one and the only national transition of care program for IC patients. First evaluations are positive but prospective evaluation studies are needed in order to limit methodologic bias.
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