Longitudinal Effects of a Multidisciplinary Heart Failure Program on Hospital Readmission: Risk Reduction and Time-to-Event Analysis
Description
Multidisciplinary program (MDP) were developed to provide coordinated, structured, and patient-centered care. Numerous studies and meta analyses have reported that MDP can reduce readmission up to 15-41%. MDP Prove to improve adherence to guideline-directed medical therapy and enhance quality of life. However, most existing studies evaluation rely on fixed time-point analysis, provided limited insight into the longitudinal evolution of readmission risk, especially in low- and middle income countries. . This study aimed to evaluate the longitudinal impact of a multidisciplinary heart failure program on hospital readmission in routine clinical practice. Specifically, we assessed the effect of program implementation on time to first heart failure readmission and the cumulative hazard of rehospitalization using survival analysis methods. By characterizing the trajectory of readmission risk following index hospitalization, this study provides insight into the temporal effects of multidisciplinary care and informs the optimization of heart failure management strategies in real-world tertiary care settings. This retrospective cohort study was conducted at Cipto Mangunkusumo General Hospital (RSCM), a tertiary referral center in Indonesia. Data obtained from Information Technology System Management Unit (ITSMU) - RSCM. Two medical care periods were compared: the standard care period (January 2017 - December 2018) and the MDP period (January 2022-December 2023). During the 8-month follow-up, 43 patients (22.7%) experienced heart failure readmission (12.2% in the multidisciplinary group vs 34.1% in standard care). Participation in the multidisciplinary program was associated with a significantly lower overall risk of readmission (RR 0.179; 95% CI 0.071-0.454; p<0.001). The largest relative reduction was observed in the first month after discharge (RR 0.155; 95%CI 0.036 - 0.673; p=0.003). In adjusted generalized linear models, the multidisciplinary program was associated with a 23% higher absolute probability of remaining readmission-free (95% CI 0.10–0.36). Time-to-event analysis demonstrated a significantly lower cumulative hazard of first readmission in the multidisciplinary group (log-rank p<0.001), with a longer median time to first readmission (106 vs 34 days).
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Institutions
- University of IndonesiaWest Java, Depok