Summary

Planning to reduce 30-day adverse events after discharge of frail elderly patients with acute heart failure: design and rationale for the DEED FRAIL-AHF trial

Martín-Sánchez FJ, Llopis García G, Llorens P, Jacob J, Herrero P, Gil V, Juan Pastor A, López-Picado A, Fuentes Ferrer M, Rosselló X, Gil P, Díez Villanueva P, Calvo E, Méndez Bailón M, Cuesta-Triana F, González Armengol JJ, González Del Castillo J, Runtkle I, Vidan MT, Comín Colet J, Cruz Jentoft A, Bueno H, Miró O, Fernández Pérez C

Affiliation of the authors

Emergency Department, Hospital Clínico San Carlos; Sanitary Research Institute of Hospital Clínico San Carlos (IdISSC); Faculty of Medicine, Universidad Complutense, Madrid, Spain. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain. Emergency Department, Short Stay Unit and Home Hospitalisation, Hospital General de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante ( (ISABIAL Foundation FISABIO); Universidad Miguel Hernández; Alicante. Emergency Department, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain. Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain. Emergency Department, Hospital Clínic, Barcelona; Research Group “ Urgencias: Procesos y Patologías”, IDIBAPS, Barcelona, Spain. Coordinator of the group of work on Units Managed for SEMES Emergencies. Clinical Research Unit and Clinical Trials, Hospital San Carlos Clinic; Platform SCReN; Sanitary Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain.Preventive Medicine, Hospital Clínico San Carlos; Sanitary Research Institute of the Hospital Clínico San Carlos (IdISSC); Faculty of Nursing, University of Nursing, Madrid, Spain. Geriatrics Service, Hospital Clínico San Carlos; Sanitary Research Institute of Hospital Clínico San Carlos (IdISSC), Faculty of Medicine, Universidad Complutense, Madrid, Spain. Cardiology Department, Hospital Universitario de la Princesa, CIBERFES, Madrid, Spain. Internal Medicine, Hospital Clínico San Carlos; Sanitary Research Institute of Hospital Clínico San Carlos (IdISSC); Faculty of Medicine, Universidad Complutense Madrid, Spain. Endocrinology and Nutrition Department, Hospital Clínico San Carlos; Sanitary Research Institute of Hospital Clínico San Carlos (IdISSC); Faculty of Medicine, Universidad Complutense Madrid, Spain. Geriatrics Department, Hospital Gregorio Marañón, Madrid, Spain. Cardiology Department, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain. Geriatrics Department, Hospital Ramón y Cajal, Madrid, Spain. Cardiology Department, Hospital Universitario 12 de Octubre; Faculty of Medicine, Universidad Complutense, Madrid, Spain.

DOI

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Quote

Martín-Sánchez FJ, Llopis García G, Llorens P, Jacob J, Herrero P, Gil V, et al. Planning to reduce 30-day adverse events after discharge of frail elderly patients with acute heart failure: design and rationale for the DEED FRAIL-AHF trial. Emergencias. 2019;31:27-35

Summary

Objectives.

To demonstrate the efficacy of a system for comprehensive care transfer (Multilevel Guided Discharge Plan [MGDP]) for frail older patients diagnosed with acute heart failure (AHF) and to validate the results of MGDP implementation under real clinical conditions. The MGDP seeks to reduce the number of adverse outcomes within 30 days of emergency department (ED) discharge.

Method.

We will enroll frail patients over the age of 70 years discharged home from the ED with a main diagnosis of AHF. The MGDP includes the following components: 1) a checklist of clinical recommendations and resource activations, 2) scheduling of an early follow-up visit, 3) transfer of information to the primary care doctor, and 4) written instructions for the patient. Phase 1 of the study will be a matched-pair cluster-randomized controlled trial. Ten EDs will be randomly assigned to the intervention group and 10 to the control group. Each group will enroll 480 patients, and the outcomes will be compared between groups. Phase 2 will be a quasi-experimental study of the intervention in 300 new patients enrolled by the same 20 EDs. The outcomes will be compared to those for each Phase-1 group. The main endpoint at 30 days will be a composite of 2 outcomes: revisits to an ED and/for hospitalization for AHF or cardiovascular death.

Conclusions.

The study will assess the efficacy and feasibility of comprehensive MGDP transfer of care for frail older AHF patients discharged home.

 

More articles by the authors

Bueno H, Calvo E, Comín Colet J, Cruz Jentoft A, Cuesta-Triana F, Díez-Villanueva P, Fernández Pérez C, Fuentes Ferrer M, Gil P, Gil V, González Armengol JJ, González Del Castillo J, Herrero P, Jacob J, Juan Pastor A, Llopis García G, Llorens P, López-Picado A, Martín-Sánchez FJ, Miró O, Méndez Bailón M, Rosselló X, Runtkle I, Vidan MT

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