{
  "abstract": "Background Reducing hospitalisations in heart failure (HF) requires organisational models for rapid optimisation, education and structured follow-up. Evidence on complex programmes in outermost or underserved regions and on the mechanisms through which they achieve their effects remains limited.Methods We conducted a convergent mixed-methods evaluation of an anonymised, culturally adapted, pharmacist-supported HF day-hospital programme implemented across two sites in an insular remote European region. The quantitative component was a self-controlled before-after study including all adults attending at least one visit between 1 January 2017 and 31 December 2021 (n=424). The primary outcome was 12-month HF rehospitalisation after versus before enrolment. Secondary outcomes were HF-related bed-days, extended 24-month utilisation, overall survival and optimisation of guideline-directed medical therapy, including quadruple therapy. The qualitative component comprised semi-structured interviews with 10 stakeholders, analysed thematically and integrated with quantitative findings.Results Using a person-time approach with post-index follow-up censored at death and capped at 12 months, HF rehospitalisation incidence rates decreased from 0.427 (95% CI 0.367 to 0.494) to 0.164 (95% CI 0.127 to 0.207) events per patient-year (incidence rate ratio (IRR) 0.38, 95% CI 0.30 to 0.48). HF bed-days rates decreased from 4.96 (95% CI 4.75 to 5.18) to 1.77 (95% CI 1.64 to 1.90) bed-days per patient-year (IRR 0.43, 95% CI 0.28 to 0.64). Overall survival was 96.0% at 12 months and 91.5% at 24 months. The programme achieved substantial optimisation of core HF therapies and uptake of quadruple therapy. Qualitative findings highlighted enabling mechanisms—multidisciplinary coordination, dedicated infrastructure, pharmacist-supported and nurse-supported titration, bilingual education and engaged leadership—and vulnerabilities including workforce constraints, telemonitoring instability and variable hospital-community integration.Conclusions In this high-risk, remote setting, this pharmacist-supported, culturally adapted HF day-hospital model was associated with major reductions in HF rehospitalisations and strong implementation of contemporary therapy, supporting integrated, context-sensitive organisational models to improve HF care quality and equity.",
  "authors": [
    {
      "affiliations": [
        "North Site Cardiology Department, University Hospital of La Réunion, Saint Denis, France"
      ],
      "name": "Marine Taranzano"
    },
    {
      "affiliations": [
        "North Site Cardiology Department, University Hospital of La Réunion, Saint Denis, France"
      ],
      "name": "Indira Cabrera Rubio"
    },
    {
      "affiliations": [
        "North Site Cardiology Department, University Hospital of La Réunion, Saint Denis, France"
      ],
      "name": "Jérôme Corré"
    },
    {
      "affiliations": [
        "Department of Clinical Research and Innovation (DRCI), University Hospital of Réunion, Saint-Denis, France"
      ],
      "name": "Sophien Horri"
    },
    {
      "affiliations": [
        "North Site Cardiology Department, University Hospital of La Réunion, Saint Denis, France"
      ],
      "name": "Dickens Fanfan"
    },
    {
      "affiliations": [
        "Cardiology Clinic, Cardiology Clinic, Saint Pierre, France"
      ],
      "name": "Sebastien Molinari"
    },
    {
      "affiliations": [
        "North Site Cardiology Department, University Hospital of La Réunion, Saint Denis, France"
      ],
      "name": "Thiziri Si Moussi"
    },
    {
      "affiliations": [
        "North Site Cardiology Department, University Hospital of La Réunion, Saint Denis, France"
      ],
      "name": "Reza Rossanaly Vasram"
    },
    {
      "affiliations": [
        "North Site Cardiology Department, University Hospital of La Réunion, Saint Denis, France"
      ],
      "name": "Shamir Vally"
    },
    {
      "affiliations": [
        "North Site Cardiology Department, University Hospital of La Réunion, Saint Denis, France"
      ],
      "name": "Jeremy Marot"
    },
    {
      "affiliations": [
        "South Site Cardiology Department, University Hospital of La Réunion, Saint Pierre, France"
      ],
      "name": "Clara Lallemand"
    },
    {
      "affiliations": [
        "South Site Cardiology Department, University Hospital of La Réunion, Saint Pierre, France"
      ],
      "name": "Romain Perrin"
    },
    {
      "affiliations": [
        "South Site Cardiology Department, University Hospital of La Réunion, Saint Pierre, France"
      ],
      "name": "Floriane Auclair"
    },
    {
      "affiliations": [
        "Pharmacy Department, North University Hospital, Saint Denis, France"
      ],
      "name": "Fanny David"
    },
    {
      "affiliations": [
        "University Hospital of La Réunion, Saint Pierre, France",
        "INSERM 1410, Saint Pierre, France"
      ],
      "name": "Catherine Marimoutou"
    },
    {
      "affiliations": [
        "North Site Cardiology Department, University Hospital of La Réunion, Saint Denis, France",
        "INSERM 1410, Saint Pierre, France"
      ],
      "name": "Louis-Marie Desroche"
    }
  ],
  "title": "Culturally adapted, pharmacist-supported heart failure day hospital: mixed-methods evaluation of outcomes and implementation mechanisms",
  "uid": "4d9e3724-4f2e-5168-ac66-36f084ea600e"
}