Characteristics of current heart failure patients admitted to internal medicine vs. cardiology: are we still caring for
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Characteristics of current heart failure patients admitted to internal medicine vs. cardiology: are we still caring for two different populations? Maria Denitza Tinti1 Received: 9 March 2020 / Accepted: 12 March 2020 © Società Italiana di Medicina Interna (SIMI) 2020
There’s growing interest in heart failure (HF) hospitalizations, because HF is now an epidemic, involving mainly older patients and causing a major burden on healthcare resources. HF patients are changing over time, with a higher number of preserved ejection fraction (HFpEF) cases, for which there is currently no effective treatment [1]. Also, primary HF hospitalizations decrease over time, whereas HF hospitalizations due to infections, kidney disease, and pulmonary disease increase [2]. Therefore, the burden of all HF hospitalizations remains substantial, and strategies to reduce it should target both cardiac disease and noncardiac comorbidities. This is particularly true in some European regions with a higher prevalence of elderly patients, like Italy. In the early 2000s the TEMISTOCLE study described the Italian perspective of HF hospitalizations in a multicenter, cardiologic (C) and internal medicine (IM) registry. In that survey, compared with cardiology managed patients, medicine cases were older, more often women, and more frequently with HFpEF. At the time, 6-month all-cause mortality was 15.5% overall and did not differ between cardiology and internal medicine, even after adjustement for covariates. Left ventricular ejection fraction (LVEF) evaluation was performed only in 41.2% of medicine patients, vs. 80.0% of cardiology patients [3]. This earlier context highlights the meaning of current studies that evaluate hospitalization trajectories in HF and their distribution, such as the study by Ricciardi et al. [4]. The VASCO (Valutazione Aziendale Scompenso CardiacO) registry provides an updated snapshot of the clinical scenario currently occurring in a large Italian hospital; as depicted by the authors, most patients with a diagnosis of HF * Maria Denitza Tinti [email protected] 1
Cardiology, San Camillo-Forlanini Hospital, Rome, Italy
are admitted to Internal Medicine units, and there are many differences in the clinical profile among patients managed in cardiology units and IM wards. As described by previous studies, there are no major variations in the clinical profile: IM patients are still older, with more comorbidities and a higher prevalence of HFpEF. It is also worth mentioning that, although years have passed, still not all these patients undergo to an evaluation of left ventricular function (in the registry LVEF was not available in 40% of patients admitted to IM vs. 4% of those admitted to C). Echocardiography is yet difficult to obtain, especially in the IM setting; that means that, while cardiologists keep caring mainly for those whom know the most, HFrEF patients, IM doctors are frequently caring for HF patients without any knowledge about their LVEF. This is a major problem, as we are expected to impl
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