Benefits of a comprehensive care model in patients with heart failure and atrial fibrillation: UMIPIC Program

Abstract

Background

Patients with heart failure (HF) and atrial fibrillation (AF) have a high risk of hospital admission and mortality. This study evaluated the benefit of a care model, characterized by comprehensive and continuous care (UMIPIC program) in patients with HF and AF.

Methods

A total of 5644 patients were prospectively recruited, of which 3005 had a history of AF between March 2008 and March 2020. They were divided into 2 follow-up groups at the time of discharge, one in the UMIPIC program (1142 patients) and another treated conventionally (1863 patients). Baseline characteristics of each group were analyzed and patients in each group were selected by propensity score matching. Admissions, mortality, incidence of stroke, intracranial hemorrhage and any other bleeding were evaluated during 12 months of follow-up, after an episode of hospitalization for HF.

Results

The UMIPIC group, compared to the conventional group in the matched cohort, had a lower rate of admissions for any cause (35.6% vs. 44.8%, respectively; hazard ratio [HR] = 0.82; 95% confidence interval [95% CI]: 0.74−0.92; p < 0.001) and lower rate of admissions for HF (18.3% vs 29.6, respectively; hazard ratio [HR] = 0.74; 95% confidence interval [95% CI]: 0.66−0.83; p < 0.001) Mortality was lower in the UMIPIC group (23.2% vs. 31%, respectively; HR = 0.82; 95% CI: 0.73−0.92; p = 0.001). No differences were found in the incidence of ischemic stroke group (1.2 vs. 0.5%, respectively; HR = 0.71; 95% CI: 0.5–1.03; p = 0.714).

Conclusions

The implementation of the UMIPIC care program for patients with HF and a history of AF, based on comprehensive and continuous care, reduces both admissions and mortality at one year of follow-up without differences in ischemic stroke incidence.

Resumen

Antecedentes

Los pacientes con insuficiencia cardíaca (IC) y fibrilación auricular (FA) presentan un riesgo elevado de ingreso hospitalario y mortalidad. En este estudio se evaluó el beneficio de un modelo asistencial, caracterizado por una atención integral y continuada (programa UMIPIC) en pacientes con IC y FA.

Métodos

Se reclutaron prospectivamente un total de 5644 pacientes, de los cuales 3005 tuvieron antecedentes de FA entre marzo de 2008 y marzo de 2020. Se dividieron en 2 grupos de seguimiento en el momento del alta, uno en el programa UMIPIC (1142 pacientes) y otro atendido de forma convencional (1863 pacientes). Se analizaron las características basales de cada grupo y se seleccionaron por emparejamiento (propensity score matching) pacientes en cada grupo. Se analizaron los ingresos hospitalarios y la mortalidad durante los 12 meses de seguimiento tras un episodio de hospitalización por IC. También se evaluó la incidencia de accidente cerebrovascular (ACV) isquémico, hemorragia intracraneal y sangrado de cualquier origen.

Resultados

El grupo UMIPIC, con respecto al convencional en la cohorte emparejada, tuvo una menor tasa de ingresos totales (35.6% vs. 44.8%, respectivamente; hazard ratio [HR] = 0.82; 95% IC 95%: 0.74−0.92; p < 0.001) así como menor tasa de ingresos por IC (18.3% vs 29.6, respectivamente; hazard ratio [HR] = 0.74; IC 95%: 0.66−0.83; p < 0.001) y menor mortalidad (23.2% vs 31%, respectivamente; HR = 0.82; IC 95%: 0.73−0.92%; p = 0.001). No se encontraron diferencias en la incidencia de ACV isquémico (1.2% vs. 0.5%, respectivamente; HR = 0.71; IC 95%: 0.5–1.03; p = 0.229)

Conclusiones

La implementación del programa asistencial UMIPIC a pacientes con IC y diagnóstico de FA basado en una atención integral y continuada, reduce tanto los ingresos como la mortalidad al año de seguimiento sin existir diferencias en la incidencia de ACV isquémico.