Care bundle to reduce readmission in patients with heart failure: a modified Delphi consensus panel in Argentina
Open Access
- 29 December 2020
- Vol. 10 (12), e040028
- https://doi.org/10.1136/bmjopen-2020-040028
Abstract
Objectives The aim of this study was to develop consensus among Argentine cardiologists on a care bundle to reduce readmissions of patients with heart failure (HF). Setting Hospitals and cardiology clinics in Argentina that provide in-hospital care for patients with HF. Participants Twenty-four cardiology experts participated in the two online rounds and 18 (75%) of them participated in the third-round meeting. Methods This 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. Results Twenty-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. Conclusion Following 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.Funding Information
- Novartis Argentina SA (NCC CLCZ696BAR05R)
This publication has 29 references indexed in Scilit:
- Angiotensin–Neprilysin Inhibition versus Enalapril in Heart FailureThe New England Journal of Medicine, 2014
- Central Line Bundle Implementation in US Intensive Care Units and Impact on Bloodstream InfectionsPLOS ONE, 2011
- Adherence to Ventilator-Associated Pneumonia Bundle and Incidence of Ventilator-Associated Pneumonia in the Surgical Intensive Care UnitArchives of Surgery, 2010
- Reduced in-hospital mortality for heart failure with clinical pathways: the results of a cluster randomised controlled trialHeart, 2009
- What Do We Know About Adherence and Self-care?Journal of Cardiovascular Nursing, 2008
- Influence of a Performance-Improvement Initiative on Quality of Care for Patients Hospitalized With Heart FailureArchives of Internal Medicine, 2007
- “Ventilator Bundle” Approach to Prevention of Ventilator-Associated PneumoniaMayo Clinic Proceedings, 2006
- Effect of Carvedilol on Survival in Severe Chronic Heart FailureThe New England Journal of Medicine, 2001
- Effects of Controlled-Release Metoprolol on Total Mortality, Hospitalizations, and Well-being in Patients With Heart FailureJAMA, 2000
- The Effect of Carvedilol on Morbidity and Mortality in Patients with Chronic Heart FailureThe New England Journal of Medicine, 1996