Case Study from The handbook

Nurse-led HF management programme in primary care, Barcelona

5 September, 2018

Healthcare institutions in the Litoral Mar area and the Catalan Health Service developed a multidisciplinary and integrated heart failure (HF) care model for primary care.

Following discharge from an acute HF episode in any hospital in Catalonia, people with HF were admitted to the nurse-led multidisciplinary programme, which integrated hospital and community resources. The programme reduced the risk of readmission and death.

A nurse-based telemedicine component has been added to the programme for high-risk patients, which has contributed to reducing hospital readmission, length of hospital stay at readmission and costs per patient after six months of follow-up.

This care model is being implemented and improved in South Metropolitan Barcelona, with coordination from the Bellvitge University Hospital.

Links, references, and key reading

Comin-Colet J, Verdu-Rotellar J, Vela E, et al. 2014. Efficacy of an integrated hospital-primary care program for heart failure: a population-based analysis of 56,742 patients. Rev Esp Cardiol (Engl Ed) 67(4): 283-93

Comin-Colet J, Enjuanes C, Verdu-Rotellar JM, et al. 2016. Impact on clinical events and healthcare costs of adding telemedicine to multidisciplinary disease management programmes for heart failure: Results of a randomized controlled trial. J Telemed Telecare 22(5): 282-95

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