P84 RAPID OPTIMIZATION OF HEART FAILURE THERAPY: ROLE OF THE HOSPITAL – TERRITORY NETWORK

Abstract

Abstract Heart Failure (HF) Guidelines take into account the close administration of the four classes of "pillar" drugs (Beta–blockers, Sacubitril–Valsartan, SGLT2i, MRA) completing their titration in the shortest possible time. The hospital outpatient clinic for HF (HOCHF), with the collaboration of the dedicated nursing clinic (DNCA), is the ideal place to follow patients (pts) in the phase immediately following discharge (7–10 days), in order to rapidly optimize the therapy and achieve stabilization: this can only be possible if the HOCHF is inserted in a Hospital–Territory–Hospital (HTH) network capable of continuing and sharing the follow up (FU) of stabilized patients. In ASL Roma 1, a HTH has been active in districts 1–2–3 since 2017, which includes the Santo Spirito Hospital –NRM, 3 Health Centers and 7 territorial outpatient clinics where 23 cardiologists and 50 nurses operate. The hospital component of the HTH is represented by the HOCHF Santo Spirito (supported by the DNC) which, thanks to the close collaboration with the territorial cardiology (TC), manages to concentrate mainly on the pts just discharged for the optimization of the therapy, on the unstable ones or the ones requiring advanced treatment. The clinic performs an average of 25 weekly examinations supported by the DNC which performs face–to–face and telephone services. In the period January – December 2022, 1,109 cardiological examinations were performed. 123 pts (mean age 76 + 4 years, 25% women) had access to the HOCHF within 10 days of discharge. The target therapy was achieved in the first 4 weeks in 42 pts (34% of the total) with 3–4 accesses. A further 50 pts achieved the therapeutic goal at 8 weeks (40.6% of the total) with 4–6 accesses. Of the remaining 31 pts, 5 (4% ​​of the total) were re–hospitalized at 30 days, 4 died (3.2% of the total), 22 (17.8% of the total) reached the target therapy in the following months. All the stabilized pts continued the FU in the proximity TC. In conclusion, in our experience, it was possible to titrate the therapy suggested by the guidelines in 74.7% of pts discharged for HF within 8 weeks. This result was obtained by focusing the activity of the HOCHF and DNC on appropriate pts, thanks to the close collaboration with the TC.