Original article
Benefits of a comprehensive care model in patients with heart failure and chronic obstructive pulmonary disease: UMIPIC Program
Beneficios de un modelo asistencial integral en pacientes con insuficiencia cardíaca y enfermedad pulmonar obstructiva crónica: Programa UMIPIC
Manuel Méndez Bailóna,
, Álvaro González-Francob, José M. Cerqueiroc, José Pérez-Silvestred, Carmen Moreno Garcíae, Alicia Conde-Martelf, José Carlos Arévalo-Loridog, Francesc Formiga Pérezh, Luis Manzano-Espinosai,1, Manuel Montero-Pérez-Barqueroj,1
Corresponding author
a Servicio de Medicina Interna, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IDISSC), Madrid, Spain
b Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
c Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain
d Servicio de Medicina Interna, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
e Servicio de Medicina Interna, Hospital de Manises, Valencia, Spain
f Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr Negrín, Gran Canaria, Spain
g Medicina Interna, Hospital Universitario de Badajoz, Badajoz, Spain
h Servicio de Medicina Interna. Hospital Universitario de Bellvitge, Barcelona, Spain
i Servicio de Medicina Interna, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
j Instituto Maimónides de Investigación Biomédica, Hospital Universitario Reina Sofía, Córdoba, Spain
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Hospital Universitario de Bellvitge, Barcelona, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Servicio de Medicina Interna, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Instituto Maimónides de Investigación Biomédica, Hospital Universitario Reina Sofía, Córdoba, Spain" "etiqueta" => "j" "identificador" => "aff0050" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Beneficios de un modelo asistencial integral en pacientes con insuficiencia cardíaca y enfermedad pulmonar obstructiva crónica: Programa UMIPIC" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-08-15" "fechaAceptado" => "2024-09-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1899334" "palabras" => array:6 [ 0 => "UMIPIC" 1 => "Heart failure" 2 => "COPD" 3 => "Readmissions" 4 => "Mortality" 5 => "Programme" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1899333" "palabras" => array:6 [ 0 => "UMIPIC" 1 => "Insuficiencia cardiaca" 2 => "EPOC" 3 => "Reingresos" 4 => "Mortalidad" 5 => "Programa" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">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 2 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.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">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 [HR] = 0.64; 95% confidence interval [95% CI]: 0.54-0.84; p = 0.002) and mortality (28% vs. 36%, respectively; HR = 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 (64% vs 54%; p < 0.05) and direct-acting anticoagulants (17% vs 9%: p < 0.05) than those followed conventionally.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">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.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con insuficiencia cardíaca (IC) y enfermedad pulmonar obstructiva crónica (EPOC) presentan un riesgo elevado de ingreso hospitalario y mortalidad. En este estudio se evaluó el beneficio de un modelo asistencial, caracterizado por una atención integral y continuada (programa UMIPIC) en pacientes con IC y antecedentes de EPOC.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se reclutaron prospectivamente un total de 5644 pacientes, de los cuales 1320 tuvieron antecedentes de EPOC entre marzo de 2008 y marzo de 2020. Se dividieron en 2 grupos de seguimiento en el momento del alta, uno en seguimiento en el programa UMIPIC (435 pacientes) y otro atendido de forma convencional (885 pacientes). Se analizaron las características basales de cada grupo y se seleccionaron por emparejamiento (<span class="elsevierStyleItalic">propensity score matching)</span> pacientes en cada grupo y se evaluaron los ingresos y la mortalidad durante 12 meses de seguimiento, tras un episodio de hospitalización por IC.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">El grupo UMIPIC, con respecto al convencional en la cohorte emparejada, tuvo una menor tasa de ingresos por IC (21% frente a 30 respectivamente; <span class="elsevierStyleItalic">hazard ratio</span> [HR] = 0,64; intervalo de confianza del 95% [IC 95%]: 0,54-0,84; p = 0.002) y de mortalidad (28% frente a 36%, respectivamente; HR = 0,68; IC 95%: 0,51-0,90; p = 0,008). Desde el punto de vista terapéutico los pacientes con IC y antecedentes de EPOC que fueron seguidos en el programa UMIPIC recibieron en mayor porcentaje betabloqueantes (63.9% vs 54.2%; p < 0.05) y de anticoagulantes de acción directa (17% vs 9%: p < 0.05) que los seguidos de forma convencional.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La implementación del programa asistencial UMIPIC a pacientes con IC y antecedentes de EPOC, basado en una atención integral y continuada, reduce tanto los ingresos como la mortalidad al año de seguimiento. La prescripción de betabloqueantes y anticoagulantes de acción directa también fue mayor durante el seguimiento en el programa UMIPIC.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Share the final authorship of the manuscript.</p>" "identificador" => "fn0005" ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/unassign/S225488742400136X/v1_202410280400/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/22548874/unassign/S225488742400136X/v1_202410280400/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225488742400136X?idApp=WRCEE" ]
