Patients hospitalized for heart failure who lack access to a specialized heart failure management program: an especially vulnerable population
S Ruiz Bustillo, N Badosa-Marce, S Valvivielso-More, M Vicente-Elcano, B J Ayala-Borges, M P Ruiz-Rodriguez, A M Linas-Alonso, F Martinez-Medina, M A Miralles-Morante, I Garcia-Nunez, S Rodriguez-Zamorano, B Vaquerizo-Montilla, L C Belarte-TorneroAbstract
Introduction
According to the clinical practice guidelines, the management of heart failure (HF) patients in multidisciplinary HF management programmes is strongly recommended to reduce hospitalizations and mortality. The high HF prevalence, the increasingly advanced age, and the frequent coexistence of comorbidities and frailty pose significant challenges to ensuring that all eligible individuals can be managed within a specialized HF unit (HFU).
Purpose
To characterize patients hospitalized for decompensated HF in clinical departments other than the cardiology department that hosts the specialized HFU.
Methods
We performed a single-center prospective observational study enrolling all patients admitted with HF in hospital departments other than cardiology between August 2024 and October 2025. Patients were identified through an internally developed automated electronic referral system, integrated into the hospital information system and connected to the HFU. This system triggers an alert that is subsequently evaluated remotely by HF cardiologists. Baseline clinical information is recorded, and the optimal post-discharge follow-up pathway is defined, with the corresponding report communicated to the patient’s primary care providers
Results
The 470 evaluated hospitalizations corresponded to 432 patients, as 38 individuals experienced more than one admission during this timeframe. Baseline characteristics showed a mean age of 85 ± 9 years, with 35% aged ≥90 years. Women represented 61% of the patients. Regarding left ventricular ejection fraction (EF), 57% had preserved EF, 7.5% mildly reduced EF, and 9.5% reduced EF. Cognitive impairment was identified in 20%. Most patients (88%) resided at home, 55% had some degree of functional dependence, and 12% lacked social support. Prior HF hospitalization was documented in 52% of participants: 26% one admission in the preceding year, 13% two admissions, and 16% more than two admissions. Nearly 48% of patients remained in the emergency department during their admission, 19.5% were hospitalized in the internal medicine ward, 14% in a peripheral subacute care facility, and 12% in the geriatrics department.
Conclusions
Patients hospitalized for HF in departments other than cardiology are predominantly women with preserved ejection fraction and constitute a markedly vulnerable population. This vulnerability is driven by their very advanced age, reflected in a considerable number of nonagenarians, as well as by the high prevalence of functional dependency and the high rate of previous HF readmissions.