Editorial comment
Heart failure hospitalization: Just a piece in the puzzle
Internamentos por Insuficiência Cardíaca: apenas uma peça no puzzle
Aurora Andrade
Clínica de Insuficiência Cardíaca, Serviço de Cardiologia, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
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"apellidos" => "Pinto" ] 14 => array:2 [ "nombre" => "Dulce" "apellidos" => "Brito" ] 15 => array:1 [ "colaborador" => "for the RICA-HFteam Investigators" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255120300020?idApp=UINPBA00004E" "url" => "/08702551/0000003800000011/v1_202002190705/S0870255120300020/v1_202002190705/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Heart failure hospitalization: Just a piece in the puzzle" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "765" "paginaFinal" => "766" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Aurora Andrade" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Aurora" "apellidos" => "Andrade" "email" => array:1 [ 0 => "amvandrade@hotmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Clínica de Insuficiência Cardíaca, Serviço de Cardiologia, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Internamentos por Insuficiência Cardíaca: apenas uma peça no <span class="elsevierStyleItalic">puzzle</span>" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Heart failure (HF) remains a major public health problem. Besides its high prevalence, it has an adverse impact on affected individuals’ quality of life, and is associated with high morbidity and mortality.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Recently, Fonseca et al. published estimates of HF prevalence and its consequences for this century in Portugal, concluding that, if current clinical practices are maintained, the prevalence of HF will increase, affecting almost half a million individuals in the coming years, with all the inherent consequences.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The natural history of HF is characterized by acute decompensation episodes. Hospitalizations, in addition to having a dramatic impact on patients’ quality of life, are a strong predictor of mortality, risk of which increases significantly with each hospitalization.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Furthermore, they have an enormous economic impact, as most of the costs of HF are due to hospitalizations.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Despite therapeutic advances in the treatment of HF, especially of chronic HF with reduced ejection fraction (HFrEF) using therapies that can dramatically improve outcomes, the prognosis of HF after hospitalization is still poor.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Although progress has been made in reducing in-hospital mortality, post-discharge readmission and mortality rates remain unacceptably high. A report from the European Society of Cardiology Heart Failure Long-Term Registry showed that all-cause mortality among acute HF patients was 4.9% during the index hospitalization and 23.6% within one year, and the incidence of the combined outcome of death or HF hospitalization within a year of discharge was 40.1%.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">After discharge, the transition phase from hospital to home is a vulnerable period, characterized by high rates of readmission.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,9</span></a> The success of this phase necessarily reflects the quality of hospital treatment but, importantly, it also requires intensive education of patients and their family or caregivers and the development of an effective transition and follow-up plan. There is no single HF care model, nor do such care models demonstrate a class effect. Successful structured HF programs should include patient education, be multidisciplinary and have specialized follow-up procedures, and care must be maintained along the continuum of HF. Patients included on well-structured HF management programs have better outcomes.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The objective of the single-center study by Agostinho et al. published in this issue of the <span class="elsevierStyleItalic">Journal</span> was to evaluate the impact of a structured follow-up program for HF patients on readmission and mortality rates and on quality of life, after an episode of hospitalization due to the syndrome.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> The study population consisted of 50 consecutive patients admitted to a general cardiology ward for acute HF between April 2016 and November 2017, who were discharged after the implementation of a protocol-based follow-up program. The control group consisted of patients discharged before the beginning of the program. The two groups were assessed using a score with three variables (New York Heart Association functional class at discharge, left ventricular ejection fraction and age). As reported by the authors, caution should be exercised in interpreting the study outcomes, as it was not a randomized controlled study and the sample size was small. Another factor that may limit the interpretation of the results includes the fact that the two groups were studied at different times.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Notwithstanding these limitations, the study's results corroborate what is reported in the literature and show that a structured HF follow-up program has a considerable impact on patients’ prognosis, with significant reductions in all-cause and HF readmission, mortality and the composite endpoint of all-cause readmission or mortality. As pointed out by the authors, the success achieved may be related to the intrinsic characteristics of the protocol; among other factors, patients included in the follow-up program were prescribed significantly more therapies with prognostic impact.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In this particular study, the fact that it is exclusively centered on the cardiologist, as stated in the protocol, is feasible for a small number of patients, but would make it difficult to implement outside the context of a clinical study. It would be desirable to extend this program and develop it using a multidisciplinary HF team approach.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Although there is no doubt about the importance of such structured follow-up programs, in Portugal there seems to be some inertia in the creation of HF management programs, as only a minority of hospital centers have actually implemented these measures. The best model for treatment of HF patients is one that fits local conditions, aiming to improve the prognosis of the patient with HF.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of chronic heart failure in Southwestern Europe: the EPICA study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 10 | 5 | 15 |
| 2024 Outubro | 43 | 33 | 76 |
| 2024 Setembro | 59 | 27 | 86 |
| 2024 Agosto | 57 | 33 | 90 |
| 2024 Julho | 56 | 38 | 94 |
| 2024 Junho | 53 | 25 | 78 |
| 2024 Maio | 27 | 22 | 49 |
| 2024 Abril | 48 | 26 | 74 |
| 2024 Maro | 34 | 21 | 55 |
| 2024 Fevereiro | 22 | 23 | 45 |
| 2024 Janeiro | 28 | 22 | 50 |
| 2023 Dezembro | 26 | 28 | 54 |
| 2023 Novembro | 40 | 28 | 68 |
| 2023 Outubro | 25 | 20 | 45 |
| 2023 Setembro | 14 | 16 | 30 |
| 2023 Agosto | 24 | 22 | 46 |
| 2023 Julho | 26 | 15 | 41 |
| 2023 Junho | 31 | 14 | 45 |
| 2023 Maio | 29 | 19 | 48 |
| 2023 Abril | 15 | 2 | 17 |
| 2023 Maro | 28 | 21 | 49 |
| 2023 Fevereiro | 24 | 22 | 46 |
| 2023 Janeiro | 18 | 13 | 31 |
| 2022 Dezembro | 35 | 27 | 62 |
| 2022 Novembro | 36 | 27 | 63 |
| 2022 Outubro | 49 | 30 | 79 |
| 2022 Setembro | 45 | 36 | 81 |
| 2022 Agosto | 29 | 35 | 64 |
| 2022 Julho | 29 | 45 | 74 |
| 2022 Junho | 34 | 40 | 74 |
| 2022 Maio | 24 | 28 | 52 |
| 2022 Abril | 28 | 32 | 60 |
| 2022 Maro | 27 | 44 | 71 |
| 2022 Fevereiro | 26 | 37 | 63 |
| 2022 Janeiro | 18 | 20 | 38 |
| 2021 Dezembro | 18 | 34 | 52 |
| 2021 Novembro | 24 | 43 | 67 |
| 2021 Outubro | 34 | 57 | 91 |
| 2021 Setembro | 30 | 30 | 60 |
| 2021 Agosto | 36 | 34 | 70 |
| 2021 Julho | 19 | 24 | 43 |
| 2021 Junho | 25 | 35 | 60 |
| 2021 Maio | 34 | 27 | 61 |
| 2021 Abril | 52 | 65 | 117 |
| 2021 Maro | 21 | 17 | 38 |
| 2021 Fevereiro | 29 | 27 | 56 |
| 2021 Janeiro | 39 | 19 | 58 |
| 2020 Dezembro | 34 | 15 | 49 |
| 2020 Novembro | 27 | 27 | 54 |
| 2020 Outubro | 33 | 23 | 56 |
| 2020 Setembro | 35 | 25 | 60 |
| 2020 Agosto | 22 | 12 | 34 |
| 2020 Julho | 18 | 15 | 33 |
| 2020 Junho | 28 | 17 | 45 |
| 2020 Maio | 29 | 9 | 38 |
| 2020 Abril | 47 | 17 | 64 |
| 2020 Maro | 81 | 33 | 114 |
| 2020 Fevereiro | 78 | 68 | 146 |
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