Hospital at home for older patients with heart failure: an observational study of the GIROT experience

Heart failure (HF) is a leading cause of hospitalization in older adults and is associated with frequent readmissions within 30 days after discharge. GIROT (Gruppo Intervento Rapido Ospedale-Territorio) model, an example of Hospital at Home (HaH) model, provides home-based care for older patients with acute conditions. This study aimed to compare hospital admissions in the 30-day and 6-month periods before and after GIROT referral.

This retrospective observational study included patients ≥ 65 years with HF, referred to GIROT between March 2022 and April 2024. Given the lack of a control group, an intra-patient comparison of the number of hospital admissions in the 30-day and 6-month periods before and after GIROT referral was performed using the Wilcoxon signed-rank test. Predictors of all-cause 6-month mortality were investigated using multivariate logistic regression.

Among 157 included participants (mean age 89; female 63.1%, 75% with moderate-to-severe disability), the number of hospital admissions decreased from a median of 1.0 to 0.0 at 1 month and from 1.0 to 0.0 at 6 months (both p < 0.001, Wilcoxon signed-rank test). Six-month mortality rate was 47%, with severe disability at the end of GIROT service period emerging as the independent predictor (OR 1.42, 95% CI 1.17-1.69). Patient and caregiver satisfaction was high (84%).

The GIROT HaH model was associated with a reduction in hospital admissions in the 1 and 6 months following the intervention in old patients with HF. Functional status, rather than comorbidities, independently predicted 6-month mortality. Further prospective studies including control groups are needed to better assess the effectiveness of this model.