Αξιολόγηση προ της εξόδου από το Νοσοκομείο Δομή εξιτηρίου

Transcription

1 Αξιολόγηση προ της εξόδου από το Νοσοκομείο Δομή εξιτηρίου Βασιλική Μπιστόλα Καρδιολόγος Μονάδα Καρδιακής Ανεπάρκειας Β Πανεπιστημιακή Καρδιολογική Κλινική ΠΓΝ ΑΤΤΙΚΟ

2 Treatment goals in AHF ESC Guidelines 2012.

3 Rehospitalization risk: Timing Post-discharge 2 months: 30% Pre-terminal 2 months: 50% Desai and Stevenson, Circulation 2012

4 Cardiac Function & CHF severity Increased mortality risk with repeat hospitalizations Risk of death increases substantially with each subsequent HF hospitalization Hospitalizat ion Hospitaliz ation Gheorghiade M et al. Am J Cardiol. 2005; 96 (6A) Hospitaliz ation Time

5 Discharge planning and follow up strategy Enrollment in a disease management program Plan to optimize medical therapies Identification of high-risk patients Transitional care Follow-up plans in place and communicated to the primary care team Aim to be reviewed by their primary care physician/gp within 1 week of discharge OR By the hospital cardiology team within 2 weeks Structured discharge summary

6 HF clinics improve outcomes Post-discharge care by specialized HF clinic vs. assistant physician Death or hospital readmission (30d) Adjusted OR (95% CI) 0.23 ( ) Azevedo A, Eur J Heart Fail 2002

7 Why are heart failure clinics effective? Reduction of mortality Initiation/up-titration of HF specific medications Reinforce treatment compliance Selection of high risk patients for advanced therapies Reduction of re-hospitalizations Assessment during the most vulnerable period after hospitalization Early detection of deterioration/congestion and appropriate adjustment of medications

8 Dose-related effects of RAASi and B-blockers on HF mortality and hospitalizations Eur Heart J. 2017;38(24):

9 Eur Heart J. 2017;38(24):

10 Circ Heart Fail. 2015;8:

11 Transitional care: methods of delivery Patient education Telephone follow up Early follow up visit after discharge Early assessment after hospital admission Medication reconciliation Home visits Communication with post-hospital care providers Bundled interventions Albert NM, Circ Heart Fail. 2015;8:

12 A 7-day follow up visit after discharge may decrease re-admissions Ryan J, Am J Med 2013

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14 ?Reduce re-hospitalizations?reduce cost?improve QOL?Best delivery method

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16 A structured discharge document for HF Int J Cardiol 2016

17 Διαφορετικές ενότητες εξιτηρίου Ιστορικό Στοιχεία νοσηλείας Αντιμετώπιση Συστάσεις Παρακολούθηση-επόμενο ραντεβού Int J Cardiol 220 (2016)

18 Στοιχεία ασθενή και νοσηλείας Int J Cardiol 220 (2016)

19 Comorbidities Komajda M et al. Eur J Heart Fail. 2016

20 Εργαστηριακός έλεγχος Int J Cardiol 220 (2016) Εξιτήριο Ασθενή με Καρδιακή Ανεπάρκεια

21 Ειδικές πληροφορίες για την Καρδιακή Ανεπάρκεια Εξιτήριο Ασθενή με Καρδιακή Ανεπάρκεια International Journal of Cardiology 220 (2016) 143

22 Elevated HR at discharge is an predictor of one-year mortality in HF patients (OFICA)

23 Φαρμακευτική αγωγή Int J Cardiol 220 (2016)

24 Άλλα καρδιολογικά και μη φάρμακα Int J Cardiol 220 (2016)

25 Συσκευές και εμβόλια Int J Cardiol 220 (2016)

26 Higher risk for incident heart failure and cardiovascular mortality among community-dwelling octogenarians without pneumococcal vaccination ESC Heart Failure 2016; 3: 11 17

27 Συστάσεις Int J Cardiol 220 (2016)

28 Προγραμματισμός επόμενων εξετάσεων Int J Cardiol 220 (2016)

29 Follow-up Int J Cardiol 220 (2016)

30 Conclusions Pre-discharge assessment should include follow up strategy planning incl. transitional care aspects, long-term follow up Multiple transitional care methods of delivery, but still the efficacy and best way of delivery not clear A structured discharge summary facilitates transitional care by enabling communication between patient, hospital doctors and primary care physician