Impact of home return assistance program (PRADO-IC) on re hospitalisation rate and mortality of hospitalized heart failure patients at one year

Introduction Congestive heart failure (CHF) is associated with prolonged and recurrent hospitalizations and the prognosis remains poor. Since 2013, the Caisse Nationale d’Assurance Maladie (CNAM) has set up a support program, PRADO-IC (support program for returning home after hospitalization for heart failure). Objective The aim of this study was to evaluate the impact of PRADO-IC on the heart failure (HF) readmission rate and death rate after one year. Method All patients hospitalized for HF at Saint-Joseph Hospital were included in an observational study from September 2016 to September 2018. Inclusion in the PRADO-IC program was at the physician's discretion. Two groups were compared according to their inclusion in PRADO-IC or not (control group (C)). The primary endpoints were the comparison of the one-year mortality and HF readmission rates between the two groups. Results In total, 633 patients were included, 262 in the PRADO-IC group and 371 in the C group. Patients in the PRADO-IC cohort more frequently presented with severity criteria (age, weight, BNP level, arrhythmia, anemia, renal failure). One-year mortality (19.5% vs. 16.2%, P=0.28) was equivalent between the two groups (Fig. 1). There were no significant differences in the one-year re-hospitalization rate for HF (35.1% in the PRADO cohort vs. 28% in the C group, P=0.06) (Fig. 2), the time to first hospitalization (74.5 days in the PRADO cohort vs. 54.5 days in the C group, P=0.55), or the length of hospitalization (6.0 days in the PRADO cohort vs. 7.0 days in the C group, P=0.29) between the two groups. Age, hyponatremia, anemia, cancer, and HF re-hospitalization were associated with a risk of mortality in multivariate analysis. Conclusion Our study shows that the PRADO-IC program concerned the most severe patients. Despite this fact, the one-year mortality and HF readmission rate were similar between the two groups.