Near‐home heart failure care

Abstract

Heart failure (HF) is a chronic progressive condition for which multidisciplinary care is recommended, preferably with active involvement of the patient and his/her carers, enhancement of self-care and focussed on avoiding preventable hospital readmissions, thus keeping the patient home as long as justified. Nurse-led HF clinics are at the centre of such care but are nearly always hospital-based, while in stabilized HF patients, self-care including drug adherence is probably best optimized in a near-home situation. Therefore, the study of Liljeroos and Strömberg is exactly what we were waiting for.1 They showed a gradual increase in HF clinics in primary care from 2 to 25 out of 27 (7% vs. 93%), between 2010 and 2017. During this time period, HF-related hospitalizations and emergency visits dropped dramatically with around 25% compared to the situation when nearly all HF care was provided by the three hospital-based HF outpatient clinics.1 In 2017, approximately 80% of the nurse-led HF care was provided in the primary care setting, leaving only patients with devices, e.g. cardiac resynchronization therapy and implantable cardioverter-defibrillator, to be cared for in the in-hospital HF clinics.1 The authors considered better drug adherence to renin–angiotensin–aldosterone system (RAAS) antagonists and beta-blockers in 326/762 (43.3%) HF patients with a left ventricular ejection fraction (LVEF) < 40% as the main driver of the drop in HF-related hospitalizations. Compared to other Swedish HF patients with a LVEF < 40% registered in the SWEDE-HF registry the ‘Sörmland county model’ achieved a 10.2% (90.4% vs. 80.2%) and 2.2% (89.6% vs. 87.4%) higher uptake of RAAS antagonists and beta-blockers, respectively.1 Two previous studies from Denmark and The Netherlands showed that the care of stabilized and optimally up-titrated HF patients could safely be transferred to primary care with the general practitioner (GP) as the key health care provider.2,3 Others examined the care and outcomes in HF patients after they visited an emergency department and found that cooperative care of cardiologist and GP resulted in lower mortality than