Benefits of a comprehensive care model in patients with heart failure and atrial fibrillation: UMIPIC Program

Abstract

Background: Patients with heart failure (HF) and atrial fibrillation (AF) 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 AF.

Methods: A total of 5644 patients were prospectively recruited, of which 3005 had a history of AF between March 2008 and March 2020. They were divided into 2 follow-up groups at the time of discharge, one in the UMIPIC program (1142 patients) and another treated conventionally (1863 patients). Baseline characteristics of each group were analyzed and patients in each group were selected by propensity score matching. Admissions, mortality, incidence of stroke, intracranial hemorrhage and any other bleeding 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 any cause (35.6% vs. 44.8%, respectively; hazard ratio [HR]=0.82; 95% confidence interval [95% CI]: 0.74-0.92; P<.001) and lower rate of admissions for HF (18.3% vs 29.6, respectively; HR=0.74; 95% confidence interval [95% CI]: 0.66-0.83; P<.001). Mortality was lower in the UMIPIC group (23.2% vs. 31%, respectively; HR=0.82; 95% CI: 0.73-0.92; P=.001). No differences were found in the incidence of ischemic stroke group (1.2 vs. 0.5%, respectively; HR=0.71; 95% CI: 0.5-1.03; P=.714).

Conclusions: The implementation of the UMIPIC care program for patients with HF and a history of AF, based on comprehensive and continuous care, reduces both admissions and mortality at one year of follow-up without differences in ischemic stroke incidence.

Keywords: Atrial fibrillation; Fibrilación auricular; Heart failure; Insuficiencia cardiaca; Mortalidad; Mortality; Programa; Programme; Readmissions; Reingresos; UMIPIC.