Improving outpatient care in chronic heart failure

Despite advances in pharma and high-technology medicine, the rate of burdensome hospital admissions and mortality in patients with chronic heart failure (CHF) remains high. Over half of all admission-entailing decompensations have been repeatedly shown to emerge from non-compliance with outpatient prescriptions. Poor adherence to medication and non-medication treatment can only be broken by improving the patient’s awareness of the disease and his closer monitoring by healthcare professionals. The power of clinical and laboratory illness monitoring in line with the recommended quality criteria of medical aid in heart failure (HF) is strongly limited today by time resources available in outpatient and midwifery clinics. Meanwhile, an international and certain domestic experience has been built up to run CHF outpatient centres with involvement of specially-trained nursing and senior medical staff. Analytic evidence on such centres suggests a reduction in mortality and hospitalisation rate among the visiting patients. To combat existing drawbacks of CHF outpatient care, the National Medical Research Center of Cardiology in alliance with the Specialist Society of Heart Failure have developed the nurses’ guidelines for CHF rooms and are launching a medical staff training programme to manage CHF rooms, registry and data analysis. Furthermore, a procedure has been developed for patient routing to regional CHF outpatient cabinets that is being actively deployed in the Tyumen Region.

1. Heidenreich P.A., Albert N.M., Allen L.A., Bluemke D.A., Butler J., Fonarow G.C., Ikonomidis J.S., Khavjou O., Konstam M.A., Maddox T.M., Nichol G., Pham M., Piña I.L., Trogdon J.G.; American Heart Association Advocacy Coordinating Committee; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Stroke Council. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ. Heart Fail. 2013; 6(3): 606–619. DOI: 10.1161/HHF.0b013e318291329a

2. Braunschweig F., Cowie M.R., Auricchio A. What are the costs of heart failure? Europace. 2011; 13 Suppl 2: ii13–17. DOI: 10.1093/europace/eur081

3. Liao L., Allen L.A., Whellan D.J. Economic burden of heart failure in the elderly. Pharmacoeconomics. 2008; 26(6): 447–462. DOI: 10.2165/00019053-200826060-00001

4. Maggioni A.P., Dahlström U., Filippatos G., Chioncel O., Crespo Leiro M., Drozdz J., Fruhwald F., Gullestad L., Logeart D., Fabbri G., Urso R., Metra M., Parissis J., Persson H., Ponikowski P., Rauchhaus M., Voors A.A., Nielsen O.W., Zannad F., Tavazzi L; Heart Failure Association of the European Society of Cardiology (HFA). EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur. J. Heart Fail. 2013; 15(7): 808–817. DOI: 10.1093/eurjhf/hft050

5. Zakharov S.V. Population of Russia 2018: twenty-sixth annual demographic report. Moscow: Izd. dom Vysshei shkoly ekonomiki; 2020. 352 p. (In Russ.). DOI: 10.17323/978-5-7598-2326-1

6. Goodman R.A., Ling S.M., Briss P.A., Parrish R.G., Salive M.E., Finke B.S. Multimorbidity Patterns in the United States: Implications for Research and Clinical Practice. J. Gerontol. A. Biol. Sci. Med. Sci. 2016; 71(2): 215–220. DOI: 10.1093/gerona/glv199

7. Sandoval C., Walter S.D., Krueger P., Smieja M., Smith A., Yusuf S., Loeb M.B. Risk of hospitalization during influenza season among a cohort of patients with congestive heart failure. Epidemiol. Infect. 2007; 135(4): 574–582. DOI: 10.1017/S095026880600714X

8. Formiga F., Chivite D., Manito N., Casas S., Llopis F., Pujol R. Hospitalization due to acute heart failure. Role of the precipitating factors. Int. J. Cardiol. 2007; 120(2): 237–241. DOI: 10.1016/j.ijcard.2006.10.004

9. Fonarow G.C., Abraham W.T., Albert N.M., Stough W.G., Gheorghiade M., Greenberg B.H., O’Connor C.M., Pieper K., Sun J.L., Yancy C.W., Young J.B.; OPTIMIZE-HF Investigators and Hospitals. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch. Intern. Med. 2008; 168(8): 847–854. DOI: 10.1001/archinte.168.8.847

10. Diaz A., Ciocchini C., Esperatti M., Becerra A., Mainardi S., Farah A. Precipitating factors leading to decompensation of chronic heart failure in the elderly patient in South-American community hospital. J. Geriatr. Cardiol. 2011; 8(1): 12–14. DOI: 10.3724/SP.J.1263.2011.00012

11. Evangelista L.S., Dracup K., Doering L.V. Treatment-seeking delays in heart failure patients. J. Heart. Lung. Transplant. 2000; 19(10): 932–938. DOI: 10.1016/s1053-2498(00)00186-8

12. Savard L.A., Thompson D.R., Clark A.M. A meta-review of evidence on heart failure disease management programs: the challenges of describing and synthesizing evidence on complex interventions. Trials. 2011; 12: 194. DOI: 10.1186/1745-6215-12-194

13. Shlyakhto E.V., Zvartau N.E., Villevalde S.V., Yakovlev A.N., Soloveva A.E., Fedorenko A.A., Karlina V.A., Avdonina N.G., Endubaeva G.V., Zaitsev V.V., Neplyueva G.A., Pavlyuk E.I., Dubinina M.V., Medvedeva E.A., Erastov A.M., Panarina S.A., Solovev A.E. Assessment of prevalence and monitoring of outcomes in patients with heart failure in Russia. Russian Journal of Cardiology. 2020; 25(12): 4204 (In Russ., English abstract). DOI: 10.15829/1560-4071-2020-4204

14. Vinogradova N.G. City Center for the Treatment of Chronic Heart Failure: the organiza-tion of work and the effectiveness of treatment of patients with chronic heart failure. Kardiologiia. 2019; 59(2S): 31–39 (In Russ., English abstract). DOI: 10.18087/cardio.2621

15. Inglis S.C., Clark R.A., McAlister F.A., Ball J., Lewinter C., Cullington D., Stewart S., Cleland J.G. Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database. Syst. Rev. 2010; (8): CD007228. DOI: 10.1002/14651858.CD007228

16. Fofanova T.V., Ageev F.T., Smirnova M.D., Deev A.D. Adherence to Therapy in the Outpatient Setting: the Ability to Identify and Assess the Effectiveness of Therapy. Kardiologiia. 2017; 57(7): 35–42 (In Russ., English abstract). DOI: 10.18087/cardio.2017.7.10004

17. Ageev F.T., Mareev V.Yu., Seredenina E.M., Belenkov Yu.N. Prospects for the introduction of specialized forms of active outpatient management of patients with heart failure: structure, methodology and preliminary results of the Russian program “ShANS”. Zhurnal Serdechnaya Nedostatochnost’. 2004; 5(6): 268–271 (In Russ., English abstract).

18. Boytsov S.A., Ageev F.T., Blankova Z.N., Svirida O.N., Begrambekova Yu.L. Guidelines for nurses and patients with chronic heart failure. Cardiovascular Therapy and Prevention. 2021; 20(1): 2754 (In Russ., English abstract). DOI: 10.15829/1728-8800-2021-2754

19. Russian Society of Cardiology (RSC). 2020 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2020; 25(11): 4083 (In Russ.). DOI: 10.15829/1560-4071-2020-4083

20. Tattersall R.L. The expert patient: a new approach to chronic disease management for the twenty-first century. Clin. Med (Lond). 2002; 2(3): 227–229. DOI: 10.7861/clinmedicine.2-3-227

21. Begrambekova Yu.L., Mareev V.Yu. Will a patient with heart failure become an expert patient? Zhurnal Serdechnaya Nedostatochnost’. 2014; 15(2): 83 (In Russ., English abstract).