Patients in community heart failure units were older with higher use of sacubitril/valsartan and SGLT2 inhibitors, while those in advanced units had more comorbidities and higher ICD use.
Observational (n=2,482)
Yes
Are there differences in patient characteristics and treatments among community, specialized, and advanced heart failure units in Spain?
There are notable differences in patient complexity and treatment patterns across different types of heart failure units in Spain, highlighting the need to optimize guideline-directed medical therapy across all settings.
Abstract Introduction Heart failure (HF) is a serious health problem and continues to have a high mortality and incidence of decompensation, despite advances in its management. The introduction of specific multidisciplinary HF units has improved the management of patients with this disease, thanks to better organization and management of available diagnostic and therapeutic resources. The HF Association of the European Society of Cardiology (ESC) and the Spanish Society of Cardiology (SEC) have defined 3 types of HF units (community, specialized, and advanced) according to their structure, complexity, and portfolio of services. Purpose To analyze in a contemporary registry of patients with HF followed up in HF units in Spain the differences in the characteristics and treatment of patients with HF attended in the three types of units. Methods We analyzed data from the registry of the SEC-Excelente-IC quality accreditation program of the Spanish Society of Cardiology, with 2,482 patients with HF included between 2019 and 2023 by 68 SEC-accredited HF units. Patients were included consecutively in two 1-month cutoffs (March and October) in that period. Units were defined as community, specialized, and advanced according to ESC HFA and SEC criteria. The characteristics and treatment received by patients in the 3 types of units were compared. Results Of the 2,482 patients, 21.3% were attended in community units, 64.1% in advanced units and 14.6% in advanced HF units. Figure 1 shows the main characteristics of the three groups. Age was higher in community units, and HFrEF, anemia, chronic kidney disease and functional class III in advanced units. There were no appreciable differences in the remaining clinical characteristics (Figure 1). Figure 2 shows the proportion of use of the different drugs in each type of unit. Except for a significant higher use of sacubitril/valsartan and SGLT2 inhibitors in community units, and that of ivabradine and diuretics in advanced units, there were no other differences in the drugs used (Figure 2). Isolated CRT implantation was higher in community unit and AID implantation, with or without CRT, was more frequent in advanced units (Figure 2). Conclusions There are notable differences between patients treated in the three types of units. Patients treated in community units are older, but patients treated in advanced units are more complex, as they have a greater number of comorbidities. Curiously, the prescription of sacubitril/valsantan and SGLT2 inhibitors is lower precisely in advanced units. However, the number of patients with ICDs is much higher in these units. We must continue to advance in the implementation of the treatments recommended by clinical practice guidelines.Main clinical features of patients
Palomas et al. (Sat,) conducted a observational in Heart failure (n=2,482). Heart failure unit type (community, specialized, advanced) vs. Comparison between unit types was evaluated on Differences in characteristics and treatment of patients with heart failure attended in the three types of units. Patients in community heart failure units were older with higher use of sacubitril/valsartan and SGLT2 inhibitors, while those in advanced units had more comorbidities and higher ICD use.