Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemic.

Heart failure (HF) is a major clinical and public health problem associated with significant mortality, morbidity, and health-care costs. Despite the existence of evidence-based guidelines for the optimal treatment of HF, the quality of care remains suboptimal. Our aim was to increase the use a care bundle in 50% of enrolled subjects during their hospitalization and discharge and to reduce their readmission for HF causes by 10%. We conducted an uncontrolled before-after study in eight hospitals in Argentina to evaluate the effect of a quality improvement intervention on the use of an HF care bundle in patients with HF New York Heart Association (NYHA) Class II-III. The HF bundle of care included medication, continuum of care, lifestyle habits, and predischarge examinations. Training and follow-up of multidisciplinary teams in each center were performed through learning sessions and plan-do-study-act improvement cycles. Data collectors reviewed bundle compliance in the health records of recruited patients after their hospital discharge and verified readmissions through phone calls to patients within 30-40 days after discharge. We recruited 200 patients (83 before and 127 during the intervention phase), and bundle compliance increased from 9.6% to 28.3% [odds ratio 3.71, 95% confidence interval (8.46; 1.63); P = .002]. Despite a slow improvement during the first months, bundle compliance gained momentum near the end of the intervention surpassing 80%. We observed a non-significant decreased readmission rate within 30 days of discharge due to HF in the postintervention period [8.4% vs. 5.5%, odds ratio 0.63, 95% CI (1.88; 0.21); P = .410]. Qualitative analysis showed that members of the intervention teams acknowledged the improvement of work organization and standardization of care, teamwork, shared mental model, and health record completeness as well as the utility of training fellows. Despite the challenges related to the pandemic, better care of patients with HF NYHA Class II-III was possible through simple interventions and collaborative work. Graphical abstract.

Care bundle to reduce readmission in patients with heart failure: a modified Delphi consensus panel in Argentina.

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.

Sarcoidosis cardíaca: descripción de tres casos / Cardiac Sarcoidosis: A Description of Three Case Reports

La sarcoidosis es una enfermedad multisistémica de etiología desconocida que puede afectar cualquier órgano. Presenta considerables diferencias en su prevalencia según los distintos países y razas. Diversas comunicaciones sugieren que el compromiso cardíaco determina mal pronóstico. Existen pocas series clínicas de sarcoidosis cardíaca en Latinoamérica y no hay consenso claro acerca de los aspectos diagnósticos y terapéuticos de esta patología. En esta presentación se describen tres casos de sarcoidosis cardíaca, sus características clínicas, electrocardiográficas, métodos de imágenes y, en dos de ellos, la anatomía patológica del material obtenido mediante biopsia endomiocárdica. Se refiere, asimismo, la evolución final de los pacientes durante el seguimiento.

Sarcoidosis is a multisystemic disease of unknown etiology that may affect any organ in the body. The prevalence of sarcoidosis varies widely in different countries and populations. Several reports have suggested that cardiac involvement is associated with adverse outcomes. There are only a few case reports of cardiac sarcoidosis in Latin America and there is no clear agreement regarding the diagnostic and therapeutic aspects of this disease. We describe three case reports of cardiac sarcoidosis with their corresponding clinical, electrocardiographic and imaging characteristics, the histopathological findings of endomyocardial biopsy in two cases, and the clinical course during follow-up.