Clinical outcomes of early post-discharge cardio-geriatric ambulatory care in frail patients after acute heart failure. A controlled before-and-after study

Abstract

Aim: To assess whether an early post-discharge Cardio-Geriatric (CG) outpatient service reduces 1-year mortality compared to usual care (UC), and to evaluate 1-year rehospitalization rates and days alive and out of hospital (DAOH).
Methods: In this single-center, controlled before-and-after study, patients aged ≥75 years hospitalized for acute HF were included. In the UC group, patients discharged between January 2018 and December 2019 received standard follow-up with referrals to a cardiologist and general practitioner. In the CG group, patients discharged between January 2020 and December 2022 attended a Cardio-Geriatric ambulatory care within three weeks of discharge. Primary outcomes were one-year all-cause mortality, heart failure readmissions, and days out of hospital (DOAH). The effectiveness of CG follow-up was assessed using a 1:1 propensity score matched (PSM) analysis.
Results: A total of 652 patients (mean age 86 years, 56% female) were included in the study, with 477 receiving UC and 175 referred to CG follow-up. After propensity score matching of 350 patients (50% CG), we observed a significant reduction in 1-year rehospitalizations (36.5% vs. 50.8%, p<0.001) and mortality (20.0% vs. 40.0%, p<0.001) in the CG group. CG patients also had nearly double the days alive and out of hospital (DAOH) compared to UC patients (300±100 vs. 162±145 days, p<0.001). Cox regression analysis confirmed that the CG integrated approach was a protective factor for mortality [HR 0.34, 95% CI: 0.24-0.47]. Respiratory diseases, neurological conditions, and infections were common causes of readmission.
Conclusion: Early referral to a CG outpatients service post-discharge for acute HF significantly improves outcomes, highlighting the value of integrated care for older adults with complex needs.