Beneficios de un modelo asistencial integral en pacientes con insuficiencia cardiaca y enfermedad pulmonar obstructiva crónica: programa UMIPIC

Abstract

Background

Patients with heart failure (HF) and chronic obstructive pulmonary disease (COPD) have a high risk of hospital admission and mortality. This study evaluated the benefit of a care model, characterized by comprehensive and continuous care (UMIPIC program) in patients with HF and a history of COPD.

Methods

A total of 5644 patients were prospectively recruited, of which 1320 had a history of COPD between March 2008 and March 2020. They were divided into two follow-up groups at the time of discharge, one in follow-up in the UMIPIC program (435 patients) and another treated conventionally (885 patients). The baseline characteristics of each group were analyzed and patients in each group were selected by propensity score matching and admissions and mortality were evaluated during 12 months of follow-up, after an episode of hospitalization for HF.

Results

The UMIPIC group, compared to the conventional group in the matched cohort, had a lower rate of admissions for HF (21 vs. 30%, respectively; hazard ratio = 0.64; 95% CI: 0.54–0.84; p = 0.002) and mortality (28 vs. 36%, respectively; hazard ratio = 0.68; 95% CI: 0.51–0.90; p = 0.008). From a therapeutic point of view, patients with HF and a history of COPD who were followed in the UMIPIC program received a higher percentage of beta-blockers (63.9 vs. 54.2%; p < 0.05) and direct-acting anticoagulants (17 vs. 9%; p < 0.05) than those followed conventionally.

Conclusions

The implementation of the UMIPIC care program for patients with HF and a history of COPD, based on comprehensive and continuous care, reduces both admissions and mortality at one year of follow-up. The prescription of beta-blockers and direct-acting anticoagulants was also higher during follow-up in the UMIPIC program.