Heart failure’s first shock and nurse-led chronic care

We study how a first heart-failure hospitalization – an adverse health shock – changes patients’ care, and whether a nurse-led chronic-care programme sustains those post-shock investments. Using linked population-wide administrative records from Italy’s Romagna Local Health Authority (2017–2023), we anchor event time at each patient’s first CHF admission and exploit staggered timing to estimate dynamic effects. The shock triggers a sharp post-discharge surge: beta-blocker adherence, cardiology follow-up, and echocardiography rise immediately, while emergency-room use spikes just before admission and then stabilizes. We then estimate the incremental impact of enrolment in the Nurse-led Program for Chronic Patients (NPCP) using the interaction-weighted event-study estimator for staggered adoption. Under conventional diff-in-diffs inference, NPCP strengthens long-run preventive engagement, with little detectable change in emergency-room use. HonestDiD sensitivity analysis indicates these gains are economically meaningful but not statistically definitive under modest departures from parallel trends.