Organization of Heart Failure Care in Spain: Characteristics of Heart Failure Units (original) (raw)

2015, Revista Española de Cardiología (English Edition)

To the Editor, Heart failure (HF) is a major health problem, and the burden it places on health care systems and society in general has increased in recent years and is expected to continue to grow. 1 Due to the wide diversity of patients with very different prognoses and therapeutic options, current guidelines recommend a multidisciplinary approach and the establishment of organizational structures to guarantee its implementation (recommendation class I A). 2 Here we present the results of the MOSAIC (Mapa de la Organización de la Insuficiencia Cardiaca en España [Map of Heart Failure Organization in Spain]) project, which updates and expands the information available about resources and organizational structures in Spain for the care of patients with HF 3 and complements the data from other recent studies conducted by the Spanish Society of Cardiology. 4 We contacted 219 of the 246 hospitals listed (89%) in the general catalog of the Spanish Ministry of Health, Social Services, and Equality (Ministerio de Sanidad, Servicios Sociales e Igualdad [MSSSI]) 5 ; 60 hospitals declined to participate, and 8 were excluded due to insufficient data. We thus present information from 151 hospitals, obtained by an online and telephone survey in the last quarter of 2011. The hospitals were classified into 3 groups according to the complexity of health care provision: level 1 (no hemodynamic monitoring, electrophysiology, or cardiac surgery), level 2 (hemodynamic monitoring and/or electrophysiology, but no surgery), and level 3 (hemodynamic monitoring, electrophysiology, and surgery). The study examined 2 types of HF unit. A general unit is a designated hospital service with an assigned manager and a specific protocol for the care of HF patients. An advanced unit has resources for the treatment of critically ill patients, including the management of advanced HF, pretransplant evaluation, hemodynamic monitoring, and ability to recommend implantation of an automated implantable cardioverter defibrillator or cardiac resynchronization device. The survey included hospitals from all 17 Spanish autonomous regions and Melilla, with a total assigned catchment population of 34.2 million people. Of these centers, 87 (57.6%) are level 1 hospitals, 33 (21.9%) are level 2, and 31 (20.5%) are level 3, the most complex level. The annual median number [interquartile range] of hospital discharges of patients admitted for all causes was 9220 [4433-20 648], and the annual number of discharges of patients admitted for HF as the main cause was 409 [156-687]. The Figure shows the proportion of centers with an HF unit broken down by unit type and compares these data with the situation in 2006 3 (although that publication did not describe the criteria used to define the hospital type, which may have differed from those used here). Of the 151 centers, 56 (37.1%) have HF units. Of these, 16 are level 1 centers (28.6% of all units), 14 (25%) are level 2 centers, and 26 (46.4%) are level 3 centers. Heart failure units are currently found in 18.4% of level 1 centers, 42.4% of level 2 centers, and 83.9% of level 3 centers, figures only slightly higher than those for 2006 (P > .05 for all comparisons). Regarding unit type, 26 hospitals have only a general unit (46.4% of centers with an HF unit and 17.2% of the total), 12 have only an advanced unit (21.4% and 7.9%), and 18 have units of both types (32.1% and 11.9%). Centers with an HF unit are larger than those without one, have higher numbers of discharges of patients admitted for all causes (median 18 906 [7962-30 984] vs 6000 [3 498-13 154]) and for HF (661 [358-1027] vs 251 [121-493]), and also have more cardiologists (17 [9-23] vs 4 [2-9]). Of the 44 general HF units (26 as the only HF unit and 18 in centers that also have advanced units), most (n = 37 [84.1%]) are managed by the cardiology service and a few (n = 6 [13.6%]) are managed by internal medicine (the corresponding figures for 2006 were 91% and 9%). The cardiology service participates in 42 of the general units (95.5% vs 96% in 2006), internal medicine in 17 (38.6% vs 11% in 2006), rehabilitation in 9 (20.5% vs 9% in 2006), and geriatrics in 4 (9.1% vs 22% in 2006)-the same