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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "352" "paginaFinal" => "353" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. González-Franco, L. Manzano" "autores" => array:2 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "González-Franco" "email" => array:1 [ 0 => "alvarogfranco@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Manzano" "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 Universitario Central de Asturias, Oviedo, Asturias, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El reto del seguimiento del paciente con insuficiencia cardiaca tras el alta, ¿son necesarios programas de gestión específicos?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Heart failure (HF) is a chronic disease with a highly significant and growing healthcare impact. 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"><span class="elsevierStyleSup">1</span></a> In Spain, approximately 700,000 people live with HF,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></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"><span class="elsevierStyleSup">3</span></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"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">5</span></a> Numerous studies<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6–9</span></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"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The article by Amores Arriaga et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> published in this issue of <span class="elsevierStyleSmallCaps">Revista Clínica Española</span> 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.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The model's systematic process mentioned in the authors’ article is similar to that implemented in the Comprehensive Management Units for Patients with HF (<span class="elsevierStyleItalic">Unidades de Manejo Integral de Pacientes con Insuficiencia Cardiaca</span>, UMIPIC)<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></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"><span class="elsevierStyleSup">14</span></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.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The study presented by Amores Arriaga et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></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.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In our opinion, the strong point of the article by Amores Arriaga et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></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.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The success of the management lies not in the magnitude of the resources but rather in proper planning and the involvement of professionals.</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: González-Franco A, Manzano L. El reto del seguimiento del paciente con insuficiencia cardiaca tras el alta, ¿son necesarios programas de gestión específicos? Rev Clin Esp. 2020;220:352–353.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.A. Heidenreich" 1 => "N.M. Albert" 2 => "L.A. Allen" 3 => "D.A. Bluemke" 4 => "J. Butler" 5 => "G. 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