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Mir&#243; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> have published a study on the use of HH in patients who come to the HED for AHF&#46; They included 1473 patients who consulted for AHF in the HED of six hospitals that participated in the multicenter prospective EAHFE Registry between 2014 and 2018&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> They evaluated adjusted adverse events at 30 days and mortality at one year based on whether the patients were transferred directly to HH versus those admitted to internal medicine wards &#40;IM&#41; or short-stay units &#40;SSU&#41;&#46; HH was the smallest group&#44; with 4&#46;7&#37; of all admitted patients&#46; The duration of stay in HH was the same as for those in IM and longer than those in SSU&#46; Mortality at one year of follow-up did not differ among the three groups &#40;HH with respect to IM&#58; HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;91&#59; 95&#37; CI&#58; 0&#46;73&#8211;1&#46;14 and with respect to SSU&#58; HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;77&#59; 95&#37; CI&#58; 0&#46;46&#8211;1&#46;27&#41;&#46; There were also no differences in mortality or readmission at 30 days&#46; A decrease in HED readmissions was observed in the HH group with respect to the other two &#40;HH-IM&#44; HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;50&#59; 95&#37; CI&#58; 0&#46;25&#8211;0&#46;97 and HH-SSU&#44; HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;37&#59; 95&#37; CI&#58; 0&#46;19&#8211;0&#46;74&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The authors conclude that there are few centers that offer HH &#40;only six of the 45 participating centers in the registry&#41; and that it is an underutilized resource&#46; According to the mortality and adverse events outcomes&#44; HH is a safe resource for patients attended to for AHF in HED compared to other types of hospitalization&#44; decreasing short-term readmissions to these departments&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The population studied includes patients with AHF without acute coronary syndrome who were not candidates for invasive interventions&#59; thus&#44; they were patients who were frail&#44; with comorbidities&#44; elderly&#44; or with terminal heart failure&#46; The progressive aging of the population in our setting&#44; in which 19&#46;1&#37; of the population is older than 65 years and 6&#46;1&#37; is older than 80 years&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> means that this type of patient is responsible for a large number of AHF consultations in HED&#44; an aspect that makes this study highly interesting&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This work seems to reinforce the safety of the HH option as well as its potential for decreasing HED readmissions&#44; a finding that has previously been described&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This type of hospitalization requires an active attitude on the part of the patient and their social environment&#44; promotes healthcare education&#44; and very likely contributes to improving the transition process between hospital care and the posterior rehabilitation process upon discharge&#46; Treatment compliance and lifestyle habits are fundamental at home&#46; In this regard&#44; HH allows for supervised training on hygienic and dietary measures&#44; such as control of diuresis and weight&#44; which are key factors for preventing future decompensations&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A meta-analysis carried out by Malik et al&#46; described a significant decrease in mortality and readmissions &#40;22&#37; vs&#46; 16&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; in patients with AHF when they developed at-home support strategies after hospital discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">A population involved in basic healthcare practices and knowledgeable about the early signs of AHF decompensation will very likely have a greater perception of control and well-being when less invasive types of hospitalization&#44; such as HH&#44; are indicated&#46; Minimizing the institutionalization of these elderly patients during hospitalizations can prevent complications&#59; for example&#44; lower rates of nosocomial infections associated with HH have been observed&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">However&#44; one of the fundamental limitations of this study lies in the heterogeneity of the three groups&#46; Patients in the HH strategy were older&#44; had a worse functional class&#44; and a lower left ventricular ejection fraction &#40;LVEF&#41;&#46; The patients in this group received higher doses of oxygen therapy and loop diuretics in perfusion in the HED and more beta blockers upon discharge&#46; On the contrary&#44; there was a higher percentage of patients hospitalized in IM who had new-onset heart failure and they presented with more severe decompensations &#40;mortality predicted by the MEESSI scale&#41;&#46; It should be noted that patients in IM&#44; whose baseline characteristics could suggest a more acute&#44; severe profile&#44; received less intensive treatment than patients in HH&#44; a fact that could have had an influence on the worse progress of these patients&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Also of note is the low implementation of optimal treatment upon discharge in the three groups with respect to beta blockers &#40;45&#37;&#41;&#44; angiotensin-converting enzyme inhibitors &#40;52&#37;&#41;&#44; and aldosterone antagonists &#40;14&#37;&#41;&#46; This is concordant with the high percentage of AHF and preserved LVEF represented in the study &#40;mean LVEF in the HH group 48&#37;&#44; IM 53&#37;&#44; SSU 56&#37;&#41;&#44; in which there is less evidence that pharmacological treatment modifies prognosis&#46; Treatment of hypertension and congestive symptoms as well as heart rate control when there is atrial fibrillation must be prioritized&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion&#44; this study supports the HH strategy in patients with AHF&#44; especially in those with preserved LVEF and advanced age who are not candidates for interventional therapies&#46; New lines of research should be proposed regarding its cost-effectiveness&#44; but its main benefits &#40;such as the reduction in nosocomial infections&#44; better adaptation to hospitalization&#44; incorporation of educational measures&#44; and the active participations of patients and those around them&#41; favor a better reincorporation into normal life after discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Though they do not show an impact on mortality&#44; these findings could explain the lower number of readmissions to HED&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In parallel&#44; we must not forget the need to strengthen other multidisciplinary integrated care units&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> the shift of healthcare processes toward outpatient procedures&#44; the creation of day hospitals&#44; and remote follow-up with telemonitoring tools<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> that allow for maintaining the benefits and preventing readmissions over longer periods of time&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; L&#243;pez-Sobrino T&#44; Andrea R&#46; Nuevos retos en insuficiencia card&#237;aca aguda&#46; M&#225;s all&#225; de la atenci&#243;n hospitalaria&#46; Rev Clin Esp&#46; 2021&#59;221&#58;26&#8211;27&#46;</p>"
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Journal Information
Vol. 221. Issue 1.
Pages 26-27 (January 2021)
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Vol. 221. Issue 1.
Pages 26-27 (January 2021)
Editorial
New challenges in acute heart failure. Beyond hospital care
Nuevos retos en insuficiencia cardíaca aguda. Más allá de la atención hospitalaria
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T. López-Sobrino, R. Andrea
Corresponding author
randrea@clinic.cat

Corresponding author.
Instituto Clínico Cardiovascular, Hospital Clínic Barcelona, IDIBAPS. Barcelona, Spain
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