Early impact of the implementation of the MAIC project and the UMIPIC programme on heart failure care in a secondary care setting
G Ropero Luis, F Guerrero-Marquez, D Zarzavilla-Benitez, M Codes-Perujo, A Rodriguez Cordoba, R Mendez Natera, N Mindiola Morales, I Jimenez-Carrillo, M Grana-CostaAbstract
Background
Integrated care models in heart failure (HF) have been proposed to improve continuity of care and clinical outcomes, although real-world evidence from routine practice remains limited.
Purpose
To assess the short-term impact of implementing the MAIC project (Models of Care for Patients with Heart Failure) and the UMIPIC programme (Comprehensive Management Unit for Patients with Heart Failure) on clinical outcomes and continuity-of-care indicators in hospitalised HF patients, compared with regional trends.
Methods
During the first quarter of 2024, a structured HF continuity-of-care protocol was implemented as part of the MAIC project, establishing predefined discharge referral pathways to Primary Care, Cardiology and Internal Medicine. In parallel, the UMIPIC programme, including outpatient consultation and day-hospital care, was launched to manage complex polypathological patients referred to internal medicine. Both interventions were implemented using existing healthcare resources with minimal additional investment. Population-based data were obtained from a regional health information system of the Sistema Sanitario Público de Andalucía. Outcomes from the year prior to implementation (2023) were compared with the first full year after implementation (2024). Indicators, defined according to the MAIC framework, included 30-day unplanned HF readmissions, 30-day HF-related emergency department visits, 30-day in-hospital mortality, early primary care contact (≤3 days), primary care contact within 3–10 days, and hospital-based follow-up within 14 days after discharge. Aggregated regional data were used as contextual reference.
Results
In 2024, HF prevalence was 3.7% in the general population and 13.9% among individuals aged over 65 years. A total of 140 HF hospitalisations were recorded in 2023 and 149 in 2024, with a comparable mean length of stay of approximately 9 days. Between 2023 and 2024, the 30-day unplanned readmission rate decreased from 8.4% to 2.6%, while remaining largely unchanged at regional level (6.6% to 6.5%). HF-related emergency department visits within 30 days declined from 13.6% to 8.0%, compared with stable regional rates (8.7% in both years). Thirty-day in-hospital mortality decreased from 30.7% to 19.5%, exceeding the modest regional reduction observed over the same period (21.3% to 19.2%). Continuity-of-care indicators improved substantially: early primary care contact increased from 55.0% to 65.1% (regional: 49.4% to 50.7%), primary care contact within 3–10 days from 44.3% to 53.7% (regional: 46.9% to 46.4%), and hospital-based follow-up within 14 days from 10.7% to 32.2%, contrasting with minimal regional variation (23.5% to 23.7%).
Conclusions
Implementation of the MAIC project and the UMIPIC programme was associated with a marked short-term improvement in clinical outcomes and continuity of care in patients hospitalised for heart failure, with gains exceeding contemporaneous regional trends.Changes in heart failure care indicatorsFor image description, please refer to the figure legend and surrounding text.