Résumé
Background: admission rates following heart failure hospitalization are high with 45% of patients who will be readmitted to hospital within a year of discharge. Transitional care services have demonstrated efficacy in meta-analyzes of randomized clinical trials, but with a moderate level of evidence and with difficulties for implementation.Objective: our study aimed to assess the efficiency of PRADO-IC, a transition care program which is nationally implemented in France, to reduce the annual heart failure readmission rate by 30% in comparison to the usual management. Methods: randomized trial on the first 215 patients included in the PRADOC study, hospitalized for HF across 5 hospitals in Occitanie, France, from May 2018 to December 2019. Patients in the intervention group received essentially an administrative assistance to schedule follow-up visits and a nurse follow-up during 2 to 6 months.Results: 215 patients were enrolled (mean age, 78 years; 59 [28.6%] women). The intervention and usual care groups were similar in baseline demographics and comorbidities. There was no significant difference between the intervention and usual care group in the primary outcome of the number of readmissions for HF at 1 year (HR, 1.15 [95% CI, 0.68-1.95]; p=0.58). There were also no significant differences between the two groups in the secondary outcomes of all-cause readmission at 1 year (HR, 0.86 [95% CI, 0.58-1.27]; p=0.40), cardiovascular death (HR, 1.99 [95% CI, 0.60-6.61]; p=0.37) all cause death at 1 year (HR, 0.93 [95% CI, 0.45-1.92]; p=0.74) and in the mean quality-of-life scores at 1 year (p=0.56).Conclusion: among patients hospitalized for HF in Occitanie, France, implementation of PRADO-IC, a patient-centered transitional care model compared with usual care failed to reduce the rate readmissions for HF. Further researches, studying the cost-effective as the PRADOC study does, are therefore essential.