DEED-FRAIL trial: A cluster-randomized trial of a frailty-oriented multicomponent ED discharge intervention for older adults with geriatric vulnerability and acute heart failure
In brief
Frailty-focused discharge plan did not significantly cut events: 13% vs 17%
In 472 older adults with acute heart failure discharged from emergency care, a multicomponent plan produced 30-day heart failure-related events in 13%, compared with 17% under usual care - a difference that was not statistically significant. Patients and caregivers reported greater satisfaction with the transition, but other clinical and patient-centered outcomes did not significantly differ.
- Journal
- European journal of internal medicine (Q1)
- Published
- 26 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Francisco Javier Martín-Sánchez, Ana Suero Roiz, María Suárez Cadenas, Patricia Parra Esquivel, Begoña Espinosa, María Pilar López Díez, et al.
- PMID
- 42800747
- DOI
- 10.1016/j.ejim.2026.107203
Why clinicians should know about it
- Picked for Internal Medicine (paper of the day, 28 September 2026): Cluster‑RCT of frailty‑oriented HF discharge
- Picked for Family Practice (paper of the day, 28 September 2026): Cluster RCT of frailty‑oriented ED discharge intervention
Abstract
OBJECTIVE: To evaluate the impact of the multilevel-guided discharge plan (MGDP) on clinical outcomes in older patients with geriatric vulnerability and acute heart failure (AHF) discharged from the ED. METHODOLOGY: DESIGN: Open-label, multicenter, cluster-randomized trial comparing patients with and without an intervention. Hospitals were matched by complexity for the cluster randomized procedure. MAIN INCLUSION CRITERIA: Age≥70 years, geriatric vulnerability (ISAR≥2 points), NT-proBNP >1800pg/mL, discharged <96 h after ED arrival. INTERVENTION: MGDP at patient discharge consisted of: 1) multidimensional checklist for clinical recommendations and activation of resources where needed; 2) early visit with the specialist scheduled; 3) information to primary care team transmitted; and 4) written instruction sheet to the patient/caregiver provided. PRIMARY OUTCOME: 30-day composite of AHF-related ED visit, hospitalization, or cardiovascular-related death. RESULTS: Twenty-three hospitals (intervention:11, control:12) included 472 patients (mean age:84 years; 57% women; intervention:231, control:241). Adherence to the mandatory core components of MGDP was high, although implementation of deficit-specific interventions varied across geriatric domains. The primary endpoint was observed in 30 and 41 patients in the intervention and control group, respectively (13.0%vs17.0%; OR:0.73, 95%CI:0.44-1.22). Interaction tests did not suggest heterogeneity across prespecified subgroups. The intervention was associated with higher patient/caregiver satisfaction with transition of care (67.2%vs47.3%; OR:2.28, 95%CI:1.50-3.47), although no significant differences were observed for other secondary clinical or patient-centered outcomes. Mixed-effects models yielded consistent findings. CONCLUSIONS: In older patients with geriatric vulnerability and AHF discharged home from the ED or related units, MGDP did not demonstrate a statistically significant reduction in 30-day adverse outcomes.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.