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

González-Franco, A.; Manzano, L.

doi:10.1016/j.rceng.2019.11.008

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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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Revista Clínica Española (English Edition)

ISSN: 2254-8874

Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI).
The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Ten issues are published each year, including mostly originals, reviews and consensus documents.

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Current Contents / Clinical Medicine , JCR / SCI-Expanded, Index Medicus / Medline y Excerpta Medica / EMBASE

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Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.3

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

0.7

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.162

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.211

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Vol. 220. Issue 6.

Pages 352-353 (August - September 2020)

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