Unidad de Insuficiencia Cardiaca, Hospital Germans Trias i Pujol, Badalona, Barcelona, España; CIBERCV, España.
Servicio de Cardiología, Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, Córdoba, España.
Rev Clin Esp (Barc). 2023 Aug-Sep;223(7):405-413. doi: 10.1016/j.rceng.2023.06.004. Epub 2023 Jun 16.
Heart failure (HF) is a complex disease with high prevalence, incidence and mortality rates leading to high healthcare burden. In Spain, there are multidisciplinary HF units coordinated by cardiology and internal medicine. Our objective is to describe its current organizational model and their adherence to the latest scientific recommendations.
In late 2021, a scientific committee (with cardiology and internal medicine specialists) developed a questionnaire that was sent as an online survey to 110 HF units. 73 from cardiology (accredited by SEC-Excelente) and 37 from internal medicine, (integrated in UMIPIC program).
We received 83 answers (75.5% total: 49 from cardiology and 34 from internal medicine). The results showed that HF units are mostly integrated by specialists from cardiology, internal medicine and specialized nurse practitioners (34.9%). Patient characteristics from HF units are widely different when comparing those in cardiology to UMIPIC, being the latter older, more frequently with preserved ejection fraction and higher comorbidity burden. Most HF units (73.5%) currently use a hybrid face-to-face/virtual model to perform patient follow-up. Natriuretic peptides are the biomarkers most commonly used (90%). All four disease-modifying drug classes are mainly implemented at the same time (85%). Only 24% of HF units hold fluent communication with primary care.
Both models from cardiology and internal medicine HF units are complementary, they include specialized nursing, they use hybrid approach for patient follow-up and they display a high adherence to the latest guideline recommendations. Coordination with primary care remains as the major improvement area.
心力衰竭（HF）是一种患病率、发病率和死亡率都很高的复杂疾病，导致医疗保健负担沉重。在西班牙，有多学科的 HF 单位，由心脏病学和内科协调。我们的目的是描述其当前的组织模式及其对最新科学建议的遵循情况。
2021 年底，一个科学委员会（由心脏病学和内科专家组成）制定了一份问卷，并将其作为在线调查发送给 110 个 HF 单位。其中 73 个来自心脏病学（SEC-Excelente 认证），37 个来自内科，（整合在 UMIPIC 项目中）。
我们收到了 83 份答复（总数的 75.5%：49 份来自心脏病学，34 份来自内科）。结果表明，HF 单位主要由心脏病学、内科和专门的护士从业者的专家组成（34.9%）。比较心脏病学和 UMIPIC 的 HF 单位的患者特征，后者的患者年龄更大，射血分数保留的情况更常见，合并症负担更高。大多数 HF 单位（73.5%）目前采用面对面/虚拟混合模式来进行患者随访。生物标志物中最常用的是利钠肽（90%）。所有四类疾病修饰药物主要同时使用（85%）。只有 24%的 HF 单位与初级保健保持流畅的沟通。
心脏病学和内科 HF 单位的两种模式是互补的，它们包括专门的护理，采用混合方法进行患者随访，并且高度遵循最新的指南建议。与初级保健的协调仍然是主要的改进领域。
