The Importance of a Heart Failure Unit in Reducing the Number of Emergency Episodes and Hospital Admissions
DOI:
https://doi.org/10.24950/rspmi.2640Palavras-chave:
Heart Failure, HospitalizationResumo
Introduction: Heart failure (HF) is a complex and multifactorial clinical syndrome with high morbidity and mortality and high healthcare costs. The integration of patients with HF into special and multidisciplinary follow-up programs aims to improve quality of life by reducing adverse events and economic costs.
The aim of this work is to analyse the impact of a HF unit of the Internal Medicine Service in reducing emergency episodes and hospitalizations related to HF.
Methods: This is a retrospective observational study that compares the proportion of adverse events related to HF between the period up to six months before and the period six months after patients were admitted to the HF unit through the Emergency Service and hospitalizations. The comparison was performed using the McNemar test.
Results: The difference in the proportion of adverse events between the period up to six months before (66%) and the period six months after admission to the unit (31%) was statistically significant (p <0.001).
Conclusion: The work of the HF unit has a positive effect on reducing the number of adverse events in these patients, removing them from the decompensation conditions that overload emergency services and hospital beds.
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Kittleson MM, Panjrath GS, Amancherla K, Davis LL, Deswal A, Dixon-DL, et al. 2023 ACC Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2023;81:1835-78. doi:10.1016/j.jacc.2023.03.393.
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure [published correction appears in Eur Heart J. 2021;42:4901. doi: 10.1093/eurheartj/ehab670]. Eur Heart J. 2021;42:3599-726. doi:10.1093/eurheartj/ehab368.
Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GM, Coats AJ. Global burden of heart failure: a comprehensive and updated review of epidemiology [published correction appears in Cardiovasc Res. 2023;119:1453. doi: 10.1093/cvr/cvad026]. Cardiovasc Res. 2023;118:3272-87. doi:10.1093/cvr/cvac013
Baptista R, Silva Cardoso J, Canhao H, Maria Rodrigues A, Kislaya I, Franco F, et al. Portuguese Heart Failure Prevalence Observational Study (PORTHOS) rationale and design - A population-based study. Rev Port Cardiol. 2023;42:985-95. doi: 10.1016/j.repc.2023.10.004.
Bate Certo Coracao [homepage na Internet]. Sociedade Portuguesa de Cardiologia; 2021 [consultado 23 Nov 2024]. Disponivel em: https://batecertocoracao.pt/index.php
Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola VP, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006;27:2725-36. doi:10.1093/eurheartj/ehl193.
Blecker S, Paul M, Taksler G, Ogedegbe G, Katz S. Heart failure–associated hospitalizations in the United States. J Am Coll Cardiol. 2013;61:1259-67. doi:10.1016/j.jacc.2012.12.038.
Greene SJ, Butler J, Albert NM, DeVore AD, Sharma PP, Duffy CI, et al. Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry. J Am Coll Cardiol. 2018;72:351-66. doi:10.1016/j.jacc.2018.04.070.
Lawson CA, Zaccardi F, Squire I, Ling S, Davies MJ, Lam CS, et al. 20-year trends in cause-specific heart failure outcomes by sex, socioeconomic status, and place of diagnosis: a population-based study. Lancet Public Health. 2019;4:e406-e420. doi:10.1016/S2468-2667(19)30108-2.
Chioncel O, Lainscak M, Seferovic PM, Anker SD, Crespo-Leiro MG, Harjola VP, et al. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2017;19:1574-85. doi:10.1002/ejhf.813.
Savarese G, Settergren C, Schrage B, Thorvaldsen T, Lofman I, Sartipy U, et al. Comorbidities and cause-specific outcomes in heart failure across the ejection fraction spectrum: A blueprint for clinical trial design. Int J Cardiol. 2020;313:76-82. doi:10.1016/j.ijcard.2020.04.068.
Savarese G, Lund LH. Global Public Health Burden of Heart Failure. Card Fail Rev. 2017;3:7-11. doi:10.15420/cfr.2016:25:2
Cook C, Cole G, Asaria P, Jabbour R, Francis DP. The annual global economic burden of heart failure. Int J Cardiol. 2014;171:368-76. doi:10.1016/j.ijcard.2013.12.028.
Gouveia MR, Ascencao RM, Fiorentino F, Costa JN, Broeiro-Goncalves PM, Fonseca MC, et al. Current costs of heart failure in Portugal and expected increases due to population aging. Rev Port Cardiol. 2020;39:3-11. doi:10.1016/j.repc.2019.09.006.
Cerqueiro JM, Gonzalez-Franco A, Montero-Perez-Barquero M, Llacer P, Conde A, Davila MF, et al. Reduction in hospitalisations and emergency department visits for frail patients with heart failure: Results of the UMIPIC healthcare programme. Rev Clin Esp. 2016;216:8-14. doi:10.1016/j.rce.2015.07.006.
Grupo de Trabajo Insuficiencia Cardiaca y Fibrilacion Auricular [homepage na Internet]. Sociedad Espanola de Medicina Interna; 2024 [consultado 24 Nov 2024]. Disponivel em: https://www.fesemi.org/grupos/cardiaca/umipic/programa
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105:S117-S314. doi:10.1016/j.kint.2023.10.018
Caraballo C, Desai NR, Mulder H, Alhanti B, Wilson FP, Fiuzat M, et al. Clinical Implications of the New York Heart Association Classification. J Am Heart Assoc. 2019;8:e014240. doi:10.1161/JAHA.119.014240
Szlagor M, Dybiec J, Młynarska E, Rysz J, Franczyk B. Chronic kidney disease as a comorbidity in heart failure. Int J Mol Sci. 2023;24:2988. doi: 10.3390/ijms24032988.
Damman K, Valente MA, Voors AA, O'Connor CM, van Veldhuisen DJ, Hillege HL. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J. 2014;35:455-69. doi:10.1093/eurheartj/eht386
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Direitos de Autor (c) 2025 Medicina Interna
Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição 4.0.
Direitos de Autor (c) 2023 Medicina Interna
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