Are degree of urbanisation and travel times to healthcare services associated with the processes of care and outcomes of heart failure? A retrospective cohort study based on administrative data.

A few studies have found that patients with heart failure (HF) living in less densely populated areas have reduced use of services and poorer outcomes. However, there is a lack of evidence regarding transport accessibility measured as the actual distance between the patient's home and the healthcare facility. The aim of this study was to investigate if different urbanisation levels and travel times to healthcare services are associated with the processes of care and the outcomes of HF. This retrospective cohort study included patients residing in the Local Healthcare Authority of Bologna (2915 square kilometres) who were discharged from hospital with a diagnosis of HF between 1 January and 31 December 2017. Six-month study outcomes included both process (cardiology follow-up visits) and outcome measures (all-cause readmissions, emergency room visits, all-cause mortality). Of the 2022 study patients, 963 (47.6%) lived in urban areas, 639 (31.6%) in intermediate density areas, and 420 (20.8%) in rural communities. Most patients lived ≤30 minutes away from the nearest healthcare facility, either inpatient or outpatient. After controlling for a number of individual factors, no significant association between travel times and outcomes was present. However, rural patients as opposed to urban patients were more likely to see a cardiologist during follow-up (OR 1.42, 99% CI 1.03-1.96). These follow-up visits were associated with reduced mortality within 6 months of discharge (OR 0.53, 99% CI 0.32-0.87). We also found that multidisciplinary interventions for HF were more common in rural than in urban settings (18.8% vs. 4.0%). In conclusion, travel times had no impact on the quality of care for patients with HF. Differences between urban and rural patients were possibly mediated by more proximal factors, some of which are potential targets for intervention such as the availability and utilisation of follow-up cardiology services and multidisciplinary models of care.

Skin antisepsis with 0.05% sodium hypochlorite before central venous catheter insertion in neonates: A 2-year single-center experience.

AIM: The study reports a 2-year single-center experience of the practice of skin antisepsis using a 0.05% sodium hypochlorite solution before central venous catheter placement in neonates. METHODS: Eligible subjects included any hospitalized neonate who needed a central line for at least 48 hours. Infants were excluded if they had a generalized or localized skin disorder. An ad hoc Excel (Microsoft Corp, Redmond, WA) file was used to record the data from each patient. The catheter sites were monitored daily for the presence of contact dermatitis. Central line-associated bloodstream infection was diagnosed according to Centers for Disease Control and Prevention definition. RESULTS: One hundred five infants underwent central venous catheter placement and were enrolled. A total of 198 central lines were inserted. The median gestational age was 31 weeks (range, 23-41 weeks) and median birth weight was 1,420 g (range, 500-5,170 g). There were no signs of 0.05% sodium hypochlorite-related skin toxicity in any infant. Of 198 catheters (1,652 catheter-days) prospectively studied, 9 were associated with bloodstream infections (5.4 per 1,000 catheter-days). CONCLUSION: During the observation period, no local adverse effects were observed suggesting that 0.05% sodium hypochlorite may be a safe choice in this context.

Effect of cardiologist care on 6-month outcomes in patients discharged with heart failure: results from an observational study based on administrative data.

OBJECTIVES: To evaluate the effect of cardiologist care on adherence to evidence-based secondary prevention medications, mortality and readmission within 6 months of discharge in patients with heart failure (HF). DESIGN: Retrospective observational study based on administrative data. SETTING: Local Healthcare Authority (LHA) of Bologna, one of the largest LHAs of Italy with ~870 000 inhabitants. PARTICIPANTS: All patients residing in the LHA of Bologna discharged from hospital with a diagnosis of HF between 1 January 2015 and 31 December 2015. PRIMARY AND SECONDARY OUTCOME MEASURES: Multivariable regression analysis was used to assess the association of inpatient and outpatient cardiologist care with adherence to evidence-based medications, all-cause mortality and hospital readmission (including emergency room visits) within 6 months of discharge. RESULTS: The study population included 2650 patients (mean age 82.3 years). 340 (12.8%) patients were discharged from cardiology wards, while 635 (24.0%) were seen by a cardiologist during follow-up. Inpatient and outpatient cardiologist care was associated with an increased likelihood of adherence to ACE inhibitors/angiotensin receptor blockers (ACEIs/ARBs), ß-blockers and aldosterone antagonists after discharge. The risk of mortality was significantly lower among patients adherent to ACEIs/ARBs and/or ß-blockers (-53% and -28%, respectively); the risk of hospital readmission was significantly lower among patients adherent to ACEIs/ARBs (-28%). CONCLUSIONS: Compared with non-specialist care, cardiologist care improves patient adherence to evidence-based medications and might thus favourably affect mortality and readmission following HF.