Outcomes of early post-discharge cardio-geriatric care in frail patients after acute heart failure: a before-and-after study
Abstract Background Despite significant advancements in heart failure (HF) management, older adults continue to face poor clinical outcomes. While an integrated, multidisciplinary approach that combines cardiology and geriatric expertise has shown considerable promise, its adoption in practice remai...
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BMC
2025-04-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-025-05883-z |
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| author | Chukwuma Okoye Tessa Mazzarone Alberto Finazzi Guarino Daniela Adriana Antonella Bruni Lorenzo Maccioni Giulia Pescatore Maria Giovanna Bianco Cinzia Guerrini Andrea Giusti Giuseppe Bellelli Agostino Virdis |
| author_facet | Chukwuma Okoye Tessa Mazzarone Alberto Finazzi Guarino Daniela Adriana Antonella Bruni Lorenzo Maccioni Giulia Pescatore Maria Giovanna Bianco Cinzia Guerrini Andrea Giusti Giuseppe Bellelli Agostino Virdis |
| author_sort | Chukwuma Okoye |
| collection | DOAJ |
| description | Abstract Background Despite significant advancements in heart failure (HF) management, older adults continue to face poor clinical outcomes. While an integrated, multidisciplinary approach that combines cardiology and geriatric expertise has shown considerable promise, its adoption in practice remains limited. This study aimed to assess whether an early post-discharge Cardio-Geriatric (CG) outpatient service could reduce 1-year mortality compared to usual care (UC), as well as evaluate its impact on 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 July 2022 attended CG ambulatory care within three weeks of discharge. Primary outcomes were one-year all-cause mortality, HF readmissions, and DOAH. The impact 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. Following a 1:1 PSM 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 median DAOH compared to UC patients (300 [IQR: 100] vs. 162 [145] days, p < 0.001). Cox regression analysis confirmed that the CG integrated approach was independently associated with a lower risk of mortality [HR 0.34, 95% CI: 0.24–0.47]. Respiratory diseases, neurological conditions, and infections were common causes of readmission. Conclusions 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. |
| format | Article |
| id | doaj-art-4e8d501c2a374bc0a6e70bf8978c7e27 |
| institution | OA Journals |
| issn | 1471-2318 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
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| series | BMC Geriatrics |
| spelling | doaj-art-4e8d501c2a374bc0a6e70bf8978c7e272025-08-20T02:17:13ZengBMCBMC Geriatrics1471-23182025-04-0125111010.1186/s12877-025-05883-zOutcomes of early post-discharge cardio-geriatric care in frail patients after acute heart failure: a before-and-after studyChukwuma Okoye0Tessa Mazzarone1Alberto Finazzi2Guarino Daniela3Adriana Antonella Bruni4Lorenzo Maccioni5Giulia Pescatore6Maria Giovanna Bianco7Cinzia Guerrini8Andrea Giusti9Giuseppe Bellelli10Agostino Virdis11School of Medicine and Surgery, University of Milano-BicoccaGeriatrics Unit, Department of Clinical and Experimental Medicine, University of PisaSchool of Medicine and Surgery, University of Milano-BicoccaGeriatrics Unit, Department of Clinical and Experimental Medicine, University of PisaFondazione IRCCS San Gerardo Dei TintoriGeriatrics Unit, Department of Clinical and Experimental Medicine, University of PisaGeriatrics Unit, Department of Clinical and Experimental Medicine, University of PisaGeriatrics Unit, Department of Clinical and Experimental Medicine, University of PisaGeriatrics Unit, Department of Clinical and Experimental Medicine, University of PisaGeriatrics Unit, Department of Clinical and Experimental Medicine, University of PisaSchool of Medicine and Surgery, University of Milano-BicoccaGeriatrics Unit, Department of Clinical and Experimental Medicine, University of PisaAbstract Background Despite significant advancements in heart failure (HF) management, older adults continue to face poor clinical outcomes. While an integrated, multidisciplinary approach that combines cardiology and geriatric expertise has shown considerable promise, its adoption in practice remains limited. This study aimed to assess whether an early post-discharge Cardio-Geriatric (CG) outpatient service could reduce 1-year mortality compared to usual care (UC), as well as evaluate its impact on 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 July 2022 attended CG ambulatory care within three weeks of discharge. Primary outcomes were one-year all-cause mortality, HF readmissions, and DOAH. The impact 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. Following a 1:1 PSM 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 median DAOH compared to UC patients (300 [IQR: 100] vs. 162 [145] days, p < 0.001). Cox regression analysis confirmed that the CG integrated approach was independently associated with a lower risk of mortality [HR 0.34, 95% CI: 0.24–0.47]. Respiratory diseases, neurological conditions, and infections were common causes of readmission. Conclusions 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.https://doi.org/10.1186/s12877-025-05883-zHeart failureFollow-upOutpatientsOutcomesCardiogeriatrics |
| spellingShingle | Chukwuma Okoye Tessa Mazzarone Alberto Finazzi Guarino Daniela Adriana Antonella Bruni Lorenzo Maccioni Giulia Pescatore Maria Giovanna Bianco Cinzia Guerrini Andrea Giusti Giuseppe Bellelli Agostino Virdis Outcomes of early post-discharge cardio-geriatric care in frail patients after acute heart failure: a before-and-after study BMC Geriatrics Heart failure Follow-up Outpatients Outcomes Cardiogeriatrics |
| title | Outcomes of early post-discharge cardio-geriatric care in frail patients after acute heart failure: a before-and-after study |
| title_full | Outcomes of early post-discharge cardio-geriatric care in frail patients after acute heart failure: a before-and-after study |
| title_fullStr | Outcomes of early post-discharge cardio-geriatric care in frail patients after acute heart failure: a before-and-after study |
| title_full_unstemmed | Outcomes of early post-discharge cardio-geriatric care in frail patients after acute heart failure: a before-and-after study |
| title_short | Outcomes of early post-discharge cardio-geriatric care in frail patients after acute heart failure: a before-and-after study |
| title_sort | outcomes of early post discharge cardio geriatric care in frail patients after acute heart failure a before and after study |
| topic | Heart failure Follow-up Outpatients Outcomes Cardiogeriatrics |
| url | https://doi.org/10.1186/s12877-025-05883-z |
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