Abstract
Heart Failure (HF) is characterized by an elevated readmission rate, with almost 50% of events occurring after the first episode over the first 6 months of the post-discharge period. In this context, the vulnerable phase represents the period when patients elapse from a sub-acute to a more stabilized chronic phase. The lack of an accurate approach for each HF subtype is probably the main cause of the inconclusive data in reducing the trend of recurrent hospitalizations. Most care programs are based on the main diagnosis and the HF stages, but a model focused on the specific HF etiology is lacking. The HF clinic route based on the HF etiology and the underlying diseases responsible for HF could become an interesting approach, compared with the traditional programs, mainly based on non-specific HF subtypes and New York Heart Association class, rather than on detailed etiologic and epidemiological data. This type of care may reduce the 30-day readmission rates for HF, increase the use of evidence-based therapies, prevent the exacerbation of each comorbidity, improve patient compliance, and decrease the use of resources. For all these reasons, we propose a dedicated outpatient HF program with a daily practice scenario that could improve the early identification of symptom progression and the quality-of-life evaluation, facilitate the access to diagnostic and laboratory tools and improve the utilization of financial resources, together with optimal medical titration and management.
Highlights
Heart Failure (HF) is the leading cause of outpatient visits in the Medicare system [1]; the increased prevalence of HF reflects a major health burden with respect to age-adjusted rates of first hospitalization, poor overall survival, and premature mortality when compared to the most common forms of cancer [2, 3]
Several items remain poorly explored; they include: (1) readmissions for worsening HF most often occur during the early months post-discharge (30 to 50% within the first 30–90 days) or in the last months before death, with similar trends among patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) [4]. (2) The EVEREST Trial clearly shows that one-third of all hospitalizations are due to non-HF-related causes, another third are due to ischemic or arrhythmic reasons, and the remaining are related to incomplete decongestion during hospitalization [5]. (3) Despite the re-hospitalization rates for HFpEF, the mechanisms leading to destabilization and the risk profile are quite different [6]
Patients affected by hypertrophic cardiomyopathy (HCM) develop more frequent HF symptoms when the hypertrophic phenotype is clearly expressed and when left ventricular outflow tract (LVOT) obstruction and/or atrial fibrillation (AF) occur [24, 25]
Summary
Heart Failure (HF) is the leading cause of outpatient visits in the Medicare system [1]; the increased prevalence of HF reflects a major health burden with respect to age-adjusted rates of first hospitalization, poor overall survival, and premature mortality when compared to the most common forms of cancer [2, 3]. Most care programs are based on the main diagnosis and the HF stages, but a model focused on specific HF etiology is lacking. For all these reasons, we propose a dedicated outpatient HF care that could improve the early identification of symptom progression and the quality-of-life evaluation, facilitate the access to diagnostic and laboratory tools and improve the utilization of evidence-based medications, with the aim of reducing HF hospitalizations. We suggest a specific model to organize an optimal network between hospital clinics, outpatient visits, peripheral medical support and patient care
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