Editorial
Towards a comprehensive and multidisciplinary care in heart failure
Hacia una atención integral y multidisciplinar en insuficiencia cardíaca
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González-Franco, J.M. Cerqueiro González, J.C. Arévalo-Lorido, P. Álvarez-Rocha, S. Carrascosa-García, A. Armengou, M. Guzmán-García, J.C. Trullàs, M. Montero-Pérez-Barquero, L. Manzano" "autores" => array:11 [ 0 => array:2 [ "nombre" => "Á." "apellidos" => "González-Franco" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Cerqueiro González" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Arévalo-Lorido" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Álvarez-Rocha" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Carrascosa-García" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Armengou" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Guzmán-García" ] 7 => array:2 [ "nombre" => "J.C." "apellidos" => "Trullàs" ] 8 => array:2 [ "nombre" => "M." "apellidos" => "Montero-Pérez-Barquero" ] 9 => array:2 [ "nombre" => "L." "apellidos" => "Manzano" ] 10 => array:1 [ "colaborador" => "on behalf of the RICA registry investigators" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S001425652100134X" "doi" => "10.1016/j.rce.2021.05.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S001425652100134X?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421001612?idApp=WRCEE" "url" => "/22548874/0000022200000003/v1_202202260708/S2254887421001612/v1_202202260708/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Towards a comprehensive and multidisciplinary care in heart failure" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "174" "paginaFinal" => "175" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Méndez-Bailón, J. Comín-Colet" "autores" => array:2 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Méndez-Bailón" "email" => array:1 [ 0 => "manuel.mendez@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Comín-Colet" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hacia una atención integral y multidisciplinar en insuficiencia cardíaca" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Heart failure (HF) is the main cause of hospital admission in individuals older than 65 years of age in Spain.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Recent epidemiological studies, conducted on the minimum basic data set (CMBD, for its initials in Spanish) of clinical information recorded in patients’ electronic medical records in Spain, show that hospitalizations for this disease are increasing, especially in elderly subjects with a high degree of comorbidity.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The one-year mortality rate of these patients is 20% and their hospital readmission rate is also not insignificant, ranging from 20% to 50%.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Many of these hospitalizations can be prevented with adequate coordination and continuity of care following hospital discharge based on multidisciplinary interventions with nursing, cardiology, internal medicine, and primary care departments.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In Spain, Heart Failure Units (HFU) have been created to improve these patients’ vital prognosis and decrease readmission rates. They are based on a culture of quick access following hospital discharge, symptoms of disease decompensation, educational interventions guided by the nursing department, and HF treatment optimization, according to the recommendations of clinical practice guidelines. At present, there are 115 HFU in Spain, 34 of which are Comprehensive Management Units for Patients with Heart Failure (UMIPIC, for its initials in Spanish) coordinated by internal medicine physicians.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Revista Clínica Española,</span> González-Franco et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> publish results on 2,862 subjects included in the Acute Heart Failure National Registry (RICA, for its initials in Spanish) of the Spanish Society of Internal Medicine (SEMI, for its initials in Spanish). The study compares patients with HF followed-up on in UMIPIC versus those who received conventional care. The authors found a significant benefit in terms of a reduction in mortality and readmissions due to HF for individuals followed-up on in the UMIPIC program.</p><p id="par0025" class="elsevierStylePara elsevierViewall">It is true that the research study published is not a randomized clinical trial and the clinical characteristics of the subjects included in the analysis were not similar among the two groups. Patients who received conventional follow-up had a higher rate of institutionalization, which may have biased the benefits of the intervention in favor of the UMIPIC program. Another aspect that should be noted is the decrease in readmissions was only attributable to HF.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In future research on the UMIPIC program, it would be interesting to know the benefit provided in terms of overall readmissions for causes other than HF. In addition, having evidence from the UMIPIC program in regard to quality of life, functional condition, and degree of satisfaction perceived by patients may be interesting indicators to evaluate in future works.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The main conclusion that can be drawn from the article published by González-Franco et al. is that providing early, multidisciplinary, continuous follow-up after discharge improves the prognosis of patients with HF, especially for subjects who are elderly and have comorbidities, adequate functional condition, and a main caregiver.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In light of these results, it seems recommendable that the implementation of UMIPIC programs be promoted more among internal medicine department in our setting in addition to a better coordination among cardiology, emergency, and primary care departments. Indeed, this is recommended in Objective 2025: Heart Failure, a recently published manifesto that is supported by numerous scientific societies which specifies that it is necessary to provide healthcare resources to hospitals nationwide to be able to accredit new units specialized in HF.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Lastly, we would like to highlight the very important role in upcoming years that adequate healthcare coordination for patients with HF by the hospital specialists who care for them and primary care departments will have. In this regard, a vision centered on each healthcare district that is community-based and with the vocation of truly integrating all affected patients in shared care processes is key for ensuring equity of care for all patients with HF.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In this age of the COVID-19 pandemic, maintaining continuity of care for chronic patients and, among them, those who have HF is truly a clinical challenge. For these reasons, the need for a comprehensive view of the process is imperative, as is the provision of care among various levels of care through the unit and by optimal professionals; prevention; and use of virtual tools for consultation, diagnostics, and clinical follow-up, which can limit in-person contact among patients and the healthcare system when it does not provide added value. Likewise, actions that allow for reducing the number of avoidable admissions or consultations and, in general, for improving the efficacy of our healthcare actions that are aimed at the patient are key.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Méndez-Bailón M, Comín-Colet J. Hacia una atención integral y multidisciplinar en insuficiencia cardíaca. Rev Clin Esp. 2022;222:174–175.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiología y tratamiento de la insuficiencia cardiaca en España: estudio PATHWAYS-HF" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Sicras-Mainar" 1 => "A. Sicras-Navarro" 2 => "B. Palacios" 3 => "L. Varela" 4 => "J.F. 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