Readmissions for Heart Failure continue to increase

Currently, in Spain, 800,000 people suffer from heart failure. (hereafter HF), a pathology that is becoming increasingly common throughout the country and whose visibility has been the subject of popular debate for several months through campaigns such as the HF week held in May or the International Congress of the ISHR (International Society for Heart Research) in June.

Broadly speaking, HF is a heart disease in which the heart is not able to pump blood to the extent necessary and, therefore, the distribution of oxygen and nutrients is insufficient in some areas and organs of the body. Although it is a pathology that mainly affects patients over 65 years of age, the progressive aging of the Spanish population makes HF an important cause of death. one of the main cardiac health problems in the country..

THE RISK

And the fact is that every year more than 100,000 hospitalizations in Spain are a direct cause of HF.according to data from the RECALCAR registry for 2021, a figure that seems to be progressively increasing. In addition, 30-day readmissions are common.and up to 15.5% of those affected by HF eventually return to the hospital as a result of this heart disease according to the RECALMIN registry in 2021.

Worsening episodes resulting from poor care of this cardiac condition. Are one of the main reasons for hospital readmission. and with each episode both the risk of readmission and death from HF increases. A potentially serious situation avoidable with proper observation and treatment.

CARE

One of the primary objectives of the National Health System (SNS) is to to delay the deterioration of patients with HF after dischargeThe use of this foresight can make a difference, both in the number of admissions avoided, patient quality of life and mortality, and in the sustainability of available resources.

Precisely for this reason, avoiding hospitalization for HF is a short- and long-term commitment that is expected to improve the NHS. And the fact is that hospital readmissions annually increase the total cost of HF substantially. In this respect, 65% of the total cost of HF is dedicated to only 15% of patientsmost of whom have been readmitted for a worsening episode. A percentage that, at the national level, translates into an investment of more than one billion euros per year..

Achieving redistribution of this expenditure is one of the main objectives of the SNS, as it would allow hospitals to. reinvest these resources among other pathologies. Similarly, another major benefit of reducing the number of patients readmitted for HF would be to achieve avoid overcrowding in hospital centers.in order to be able to offer a much more efficient overall response.

“Without care, symptoms worsen”

From Prensa Ibérica, we spoke with Dr. Nicolas Manito Lorite to learn a little more in depth about the situation of Heart Failure in Spain.

What do we mean when we talk about HF?

HF is a disease in which the heart is unable to pump blood and properly maintain the needs of oxygen and nutrients for all the organs of our body. It can present chronically or acutely and its debut usually involves a visit to the emergency room or hospitalization.

What are the symptoms?

The most common are fatigue, tiredness, shortness of breath, chest pain, dizziness, and sometimes loss of consciousness or syncope. In addition, there may also be fluid retention (such as swelling of the ankles and abdomen), palpitations, decubitus intolerance and irritative cough together with shortness of breath, especially at night.

What are the causes?

The risk factors for developing HF are mainly diseases of the cardiac coronary arteries (such as myocardial infarction or angina pectoris), heart muscle diseases, heart valve lesions, arrhythmias such as atrial fibrillation, poorly controlled arterial hypertension and toxic causes such as alcohol. Therefore, signs and symptoms of HF require diagnostic tests such as electrocardiogram, echocardiography, magnetic resonance imaging, holter, cardiac catheterization and a complete blood analysis.

What are the consequences of poor care?

Symptoms often worsen leading to risk of sudden death (in many cases from severe arrhythmias) and hospitalization, which in turn increases the risk of other organ failures such as kidney, liver, lungs and brain. In addition, after hospitalization for HF, one in four patients dies within one year of follow-up.

Is there a treatment?

The first thing is to be aware of the serious health problem of poorly controlled and worsening HF, since with each episode, the risk of readmission and death due to HF increases significantly.

There are many actions we can take to prevent readmissions. A first solution would be to act earlier after discharge with the optimization of new treatments that have been shown to prevent HF readmissions. In those patients who are symptomatic despite being treated with oral drugs, there are other treatment possibilities with pacemakers called tricameral pacemakers and implantable defibrillators.

In view of the above, it is necessary to promote revisions of the care processes in our hospitals to avoid hospitalizations, and these organizational changes correspond both to the NHS and to the professionals who care for the HF patient. This organizational objective requires different phases to be addressed efficiently, so that the situation of patients with the highest percentage of readmissions should be addressed first and foremost, with which a greater return on investment on the part of the NHS could be achieved.