Multidisciplinary home-based nursing interventions for advanced heart failure: impact on hospitalizations and emergency visits
B Lage Garcia, A M Pinto, M Castro, L Pinheiro, E Mata, M Tinoco, F Cardoso, F Almeida, L Calvo, A LourencoAbstract
Background
Heart failure (HF) often leads to recurrent emergency department (ED) visits and hospitalizations, reflecting high symptom burden and poor quality of life. Home-based multidisciplinary unit (HBMU) programs with ambulatory IV diuretic therapy have emerged as a strategy to improve self-management, optimize decongestion, and reduce healthcare use in advanced HF.
Purpose
To assess the impact of an HBMU program incorporating ambulatory IV diuretic on hospitalizations and ED visits among patients with terminal HF.
Methods
This retrospective single-center study included 28 patients who received IV diuretic therapy through a HBMU program between 2018 and 2025. Eligibility was defined by the attending cardiologist for patients with recurrent hospitalizations for decompensated HF, IV diuretic dependence, and persistent NYHA class III–IV symptoms. Patients were visited at least weekly by a specialized nursing team, with findings communicated to the cardiologist. Baseline characteristics were collected at enrollment. The impact of the program on hospitalization and ED visit rates was evaluated by comparing the 12-month period preceding HBMU enrollment with the entire duration of participation in the program using generalized estimating equations with negative binomial models adjusted for time exposure.
Results
Patients were elderly (mean age 74.6±10 years), predominantly male (60.7%), with advanced HF (mean LVEF 35.8±13.6%). Most had chronic kidney disease (85.7%) and marked functional dependence (53.6% with mRankin≥3). Median follow-up in the HBMU program was 121 days [24–277]. Following HBMU enrollment, the rate of all-cause hospitalizations decreased by 47% (p=0.002), while the composite rate of all-cause ED visits and hospitalizations decreased by 46% (p=0.003). A non-significant reduction was observed in HF-related hospitalizations (rate ratio: 0.65; p=0.11). The composite of all-cause ED visits and HF hospitalizations demonstrated a 40% lower event rate (p=0.028).
Conclusions
Implementation of HBMU programs with IV diuretic therapy in terminal HF patients significantly reduced hospitalizations rate and ED visits. Given the more advanced disease stage and poorer prognosis during the HBMU period compared with the preceding comparator period, the observed benefit is likely underestimated. These findings underscore the potential value of structured home-based IV diuretic therapy in optimizing care and reducing healthcare utilization in advanced HF.For image description, please refer to the figure legend and surrounding text.