Inclusion into a heart failure critical pathway reduces the risk of death or readmission after hospital discharge

Eur J Intern Med. 2012 Dec;23(8):760-4. doi: 10.1016/j.ejim.2012.06.006. Epub 2012 Jul 2.


Background: Evidence-based therapies can lower the risk of death or hospital admission in heart failure (HF) patients, but are underprescribed. Critical pathways are one means of supporting systematic use of evidence-based recommendations.

Methods: Patients admitted for HF in one hospital in 2009 and included in a critical pathway were compared with a control group of patients admitted in 2007. The primary endpoint was the risk of death or readmission within 90 days after discharge. The hazard ratio of death or readmission was evaluated in a multivariate Cox proportional hazard model adjusting for age, sex, co-morbidities, and length of stay.

Results: Three hundred and sixty-three patients were evaluated (151 in the critical pathway and 212 in the control group). Adjusted hazard ratio for death or readmission at 90 days was 0.72 (95 CI 0.51-1.00, p=0.049). Adhesion to guidelines was significantly better for patients included in the critical pathway (p=0.004), with more frequent prescription of beta-blockers (70.9% (95% CI 62.9-78.0) vs. 56.6% (95% CI 49.6-63.4), p=0.006), and evaluation of left ventricular ejection fraction (LVEF, 73.5% (95% CI 65.7-80.3) vs. 57.5% (95% CI 50.6-64.3), p=0.002). Patients with reduced LVEF seem to have benefited the most from the inclusion in the critical pathway.

Conclusions: Implementation of a critical pathway for patients hospitalized for HF was associated with a 28% reduction of the relative risk of death or readmission and improved adhesion to guidelines.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Critical Pathways / standards
  • Critical Pathways / statistics & numerical data*
  • Evidence-Based Practice / standards
  • Evidence-Based Practice / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Guideline Adherence / standards
  • Guideline Adherence / statistics & numerical data
  • Heart Failure / mortality*
  • Heart Failure / therapy*
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Outcome Assessment, Health Care / methods*
  • Outcome Assessment, Health Care / standards
  • Patient Discharge / standards
  • Patient Discharge / statistics & numerical data*
  • Patient Readmission / standards
  • Patient Readmission / statistics & numerical data*
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors