PT  - JOURNAL ARTICLE
AU  - Javier Roberti
AU  - Tomás Vita
AU  - Jimena Piastrella
AU  - Carlos Porley
AU  - Lisandro Pereyra
AU  - Mirta Diez
AU  - Florencia Renedo
AU  - Enrique Fairman
AU  - Alberto Fernández
AU  - Jorge Thierer
AU  - Ezequiel García Elorrio
TI  - Care bundle to reduce readmission in patients with heart failure: a modified Delphi consensus panel in Argentina
AID  - 10.1136/bmjopen-2020-040028
DP  - 2020 Dec 01
TA  - BMJ Open
PG  - e040028
VI  - 10
IP  - 12
4099  - http://bmjopen.bmj.com/content/10/12/e040028.short
4100  - http://bmjopen.bmj.com/content/10/12/e040028.full
SO  - BMJ Open2020 Dec 01; 10
AB  - Objectives The aim of this study was to develop consensus among Argentine cardiologists on a care bundle to reduce readmissions of patients with heart failure (HF).Setting Hospitals and cardiology clinics in Argentina that provide in-hospital care for patients with HF.Participants Twenty-four cardiology experts participated in the two online rounds and 18 (75%) of them participated in the third-round meeting.Methods This study used a mixed-method design; it was conducted between August 2019 and January 2020. The development of a care bundle (a set of evidence-based interventions applied to improve clinical outcomes) involved three phases: (1) a literature review to define the list of interventions to be evaluated; (2) a modified Delphi panel to select interventions for the bundle and (3) definition of the HF care bundle. Also, the process included three rounds of scoring.Results Twenty-six interventions were evaluated. The interventions in the final bundle covered four categories: medication, continuum of care, lifestyle habits, predischarge tests. These were: medication: beta-blockers, angiotensin receptor neprilysin inhibitors or ACE-inhibitors, furosemide and antimineralocorticoids; continuum of care: follow-up appointment, daily weight monitoring; lifestyle habits: smoking cessation counselling and low-sodium diet; predischarge tests: renal function, ionogram, blood pressure control, echocardiogram and determination of decompensating cause.Conclusion Following a systematic mixed-method approach, we have developed a care bundle of interventions that could decrease readmission of patients with HF. The application of this bundle could contribute to scale evidence-based interventions.