The challenge of following up patients with heart failure after discharge. Are specific management programs needed?

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At present, more than 23 million people worldwide are afflicted by this medical condition, and the prevalence of HF is expected to increase by 25% by 2030.<a class="elsevierStyleCrossRef" href="#bib0070">1</a> In Spain, approximately 700,000 people live with HF,<a class="elsevierStyleCrossRef" href="#bib0075">2</a> which represents a prevalence of 4.7–6.8% in individuals older than 45 years, increasing to 16% for those older than 75 years.<a class="elsevierStyleCrossRef" href="#bib0080">3</a> HF is the main cause of hospitalization for patients older than 65 years, is progressively increasing and comprises more than 100,000 hospitalizations annually, according to the latest available information.<a class="elsevierStyleCrossRef" href="#bib0085">4</a>HF is also responsible for 3.8% of healthcare expenditures, in large part due to the consumption of hospital resources, with a mean of 2 emergency department visits and at least 1 hospitalization every year per patient.<a class="elsevierStyleCrossRef" href="#bib0090">5</a> Numerous studies<a class="elsevierStyleCrossRefs" href="#bib0095">6–9</a> have recently shown that the hospitalization of a patient with HF is not a trivial event but rather one that causes a period of greater vulnerability to new decompensations during the first 30 days after discharge. Closer follow-up of patients during this transition period is therefore necessary, given that this period is obviously the most vulnerable for patients with HF and requires systematic planning for the continuity of care in outpatient settings. Based on this evidence, authors have suggested the need for encouraging the development of efficient transition models, based on early reviews with support from nursing and appropriate coordination with other healthcare levels, rather than the classical models, which usually offer more delayed reviews and little involvement by primary care.<a class="elsevierStyleCrossRefs" href="#bib0115">10,11</a>The article by Amores Arriaga et al.<a class="elsevierStyleCrossRef" href="#bib0125">12</a> published in this issue of Revista Clínica Española showed how a simple postdischarge HF transition program, conducted mainly by nursing staff with the option of flexible reviews in a specialized consultation for complex chronic patients, can achieve excellent results in reducing hospitalizations and emergency department visits.The model's systematic process mentioned in the authors’ article is similar to that implemented in the Comprehensive Management Units for Patients with HF (Unidades de Manejo Integral de Pacientes con Insuficiencia Cardiaca, UMIPIC)<a class="elsevierStyleCrossRef" href="#bib0130">13</a> program launched throughout Spain since November 2011, which is endorsed by the Spanish Society of Internal Medicine and to which 35 internal medicine departments are currently subscribed. The UMIPIC program emerged with the primary objective of reducing the hospitalizations of complex chronic patients with HF and increasing their quality of life. The program is built on 3 essential pillars: education by specialized nursing, patient and main caregiver involvement and comprehensive care provided by medical internists. The results can be qualified as highly relevant, with a greater than 85% reduction in hospital admissions for HF and a greater than 70% reduction in emergency department visits for HF during the first year of follow-up in the units compared to the year prior to the departments’ incorporation in the program.<a class="elsevierStyleCrossRef" href="#bib0135">14</a> Overall, these data demonstrate that a program focused on caring for frail elderly patients with multiple diseases and a high risk of presenting adverse events is clearly effective and requires internal reorganization of the internists’ tasks and the creation of a specialized consultation with the incorporation of a nurse.The study presented by Amores Arriaga et al.<a class="elsevierStyleCrossRef" href="#bib0125">12</a> did not assess the impact on mortality; however, this does not detract from its validity, especially at a time when efforts to develop healthcare pathways are being advocated that effectively integrate healthcare levels and prevent the fragmentation that these patients often present.In our opinion, the strong point of the article by Amores Arriaga et al.<a class="elsevierStyleCrossRef" href="#bib0125">12</a> is the demonstration that a simple consultation, focused on patients with HF and a high risk of readmission, implementable in any internal medicine department, with the support of nursing and flexibility in the follow-up after HF decompensation, provides a highly significant benefit in managing this patient profile.The success of the management lies not in the magnitude of the resources but rather in proper planning and the involvement of professionals." 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Fonarow" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/HHF.0b013e318291329a" "Revista" => array:6 [ "tituloSerie" => "Circ Heart Fail" "fecha" => "2013" "volumen" => "6" "paginaInicial" => "606" "paginaFinal" => "619" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23616602" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0075" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "<a target="_blank" href="https://vizhub.healthdata.org/gbd-compare">https://vizhub.healthdata.org/gbd-compare</a> [accessed 05.11.19]." ] ] ] 2 => array:3 [ "identificador" => "bib0080" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia de la insuficiencia cardiaca en la población general española mayor de 45 años. Estudio PRICE" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Anguita Sánchez" 1 => "M.G. Crespo Leiro" 2 => "E. de Teresa Galván" 3 => "M. Jiménez Navarro" 4 => "L. Alonso-Pulpón" 5 => "J. Muñiz García" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1157/13126044" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2008" "volumen" => "61" "paginaInicial" => "1041" "paginaFinal" => "1049" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18817680" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0085" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Heart Failure Matters. Qué es la insuficiencia cardiaca. Available from: <a target="_blank" href="http://pestadistico.inteligenciadegestion.msssi.es/publicoSNS/comun/Cubo.aspx?IdNodo=6390">http://pestadistico.inteligenciadegestion.msssi.es/publicoSNS/comun/Cubo.aspx?IdNodo=6390</a> [accessed 05.11.19]." ] ] ] 4 => array:3 [ "identificador" => "bib0090" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiología de la insuficiencia cardiaca aguda" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Montes-Santiago" 1 => "J.C. Arévalo Lorido" 2 => "J.M. Cerqueiro González" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2014" "volumen" => "142" "numero" => "Suppl. 1" "paginaInicial" => "3" "paginaFinal" => "8" "itemHostRev" => array:3 [ "pii" => "S0190962219328191" "estado" => "S300" "issn" => "01909622" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0095" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trends, causes and timing of 30-day readmissions after hospitalization for heart failure: 11-year population-based analysis with linked data" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Fernandez-Gasso" 1 => "L. Hernando-Arizaleta" 2 => "J.A. Palomar-Rodríguez" 3 => "M.V. Abellán-Pérez" 4 => "D.A. Pascual-Figal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2017.07.094" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2017" "volumen" => "248" "paginaInicial" => "246" "paginaFinal" => "251" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28801153" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0100" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of the hospital readmissions reduction program implementation with readmission and mortality outcomes in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Gupta" 1 => "L.A. Allen" 2 => "D.L. Bhatt" 3 => "M. Cox" 4 => "A.D. DeVore" 5 => "P.A. Heidenreich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamacardio.2017.4265" "Revista" => array:6 [ "tituloSerie" => "JAMA Cardiol" "fecha" => "2018" "volumen" => "3" "paginaInicial" => "44" "paginaFinal" => "53" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29128869" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0105" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transitional care interventions to prevent readmissions for people with heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. John" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2015" "editorial" => "Eisenberg Center for Clinical Decisions and Communications Science" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0110" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transitional care for patients with congestive heart failure: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I. Vedel" 1 => "V. Khanassov" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1370/afm.1844" "Revista" => array:6 [ "tituloSerie" => "Ann Fam Med" "fecha" => "2015" "volumen" => "13" "paginaInicial" => "562" "paginaFinal" => "571" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26553896" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0115" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transitions of care in heart failure: a scientific statement from the American Heart Association" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.M. Albert" 1 => "S. Barnason" 2 => "A. Deswal" 3 => "A. Hernandez" 4 => "R. Kociol" 5 => "E. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/HHF.0000000000000006" "Revista" => array:6 [ "tituloSerie" => "Circ Heart Fail" "fecha" => "2015" "volumen" => "8" "paginaInicial" => "384" "paginaFinal" => "409" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25604605" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0120" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transiciones de cuidados entre insuficiencia cardiaca aguda y crónica: pasos críticos en el diseño de un modelo de atención multidisciplinaria para la prevención de la hospitalización recurrente" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Comín-Colet" 1 => "C. Enjuanes" 2 => "J. Lupón" 3 => "M. Cainzos-Achirica" 4 => "N. Badosa" 5 => "J.M. Verdú" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rec.2016.05.001" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2016" "volumen" => "69" "paginaInicial" => "951" "paginaFinal" => "961" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27282437" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0125" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Resultados del seguimiento en una consulta monográfica tras el alta por insuficiencia cardiaca" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Amores" 1 => "C. Josa" 2 => "V. Garcés Horna" 3 => "M. Sánchez" 4 => "P. Sampériz Legarre" 5 => "F. Ruiz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2019.08.008" "Revista" => array:3 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2020" "itemHostRev" => array:3 [ "pii" => "S0190962218327464" "estado" => "S300" "issn" => "01909622" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0130" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Sociedad Española de Medicina Interna. Grupos de Trabajo. Grupo de Trabajo Insuficiencia Cardiaca y Fibrilación Auricular. Programa UMIPIC [consultado 5 Nov 2019]. Disponible en: <a target="_blank" href="https://www.fesemi.org/grupos/cardiaca/umipic/programa">https://www.fesemi.org/grupos/cardiaca/umipic/programa</a>" ] ] ] 13 => array:3 [ "identificador" => "bib0135" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reducción de ingresos y visitas a Urgencias en pacientes frágiles con insuficiencia cardíaca: resultados del programa asistencial UMIPIC" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Cerqueiro" 1 => "A. Gonzalez-Franco" 2 => "M. Montero-Perez-Barquero" 3 => "P. Llacer" 4 => "A. Conde" 5 => "M.F. Davila" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2015.07.006" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp." 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