Implementation of a heart failure clinic in a non-cardiovascular center in Mexico
Authors: Bayardo Gonzalez J , Oseguera Moguel J , Barron Magdaleno C , Payro Ramirez G , Orihuela C , Galindo Uribe J , Dorantes Garcia J , Narvaez R , Hernandez Reyes P , Vazquez Ortiz Z , Cazares Diaz A 
Published: October 2022

Abstract

Introduction
The incidence and prevalence of Heart Failure (HF) has been increasing throughout these years, with it, the need to implement HF clinics. In Latin America, it is rare to find non-cardiovascular centers with the capacity, human resources, and infrastructure to make this project sustainable, viable and useful for patients. Our center is a highly concentrated hospital in the country, with patients referred from different areas of Mexico. This makes it a unique site of multiple rare pathologies in the general population.

Objectives
To determine if there is a relationship between the implementation of a HF clinic and the decrease in mortality, the rate of rehospitalization of patients with HF over 6 months, as well as to implement and optimize the therapy of mainstay drugs for HF and the timely referral of the hospitalized or ambulatory patient, for follow-up, control, and education of HF.

Methods
A prospective descriptive study was designed with analytical intent. 80 patients with a diagnosis of HF were included. A comprehensive system was used to collect objective and subjective patient data through a database. The information was obtained from the review of medical records and by telephone follow-up of the patients. Each patient was evaluated at the first consultation with Brain Natriuretic Peptide (BNP) values, iron profile, troponin I, blood cytometry and complete blood chemistry. Follow-up appointments included BNP, nitrogen products and VExUS protocol for drug titration, study of reversible causes of HF, assessment of ejection fraction evolution, decision making regarding the indication of devices such as implantable defibrillator and resynchronizer, and scheduled appointments according to functional class and unscheduled appointments in case of alarm signs.

Results
Of the 80 total patients included in our registry during the first 6 months, we found the presence of Heart failure with reduced ejection fraction (HFrEF) in 66% of our patients, of whom 46% were reclassified as recovered Heart failure with recovered ejection fraction at the end of these first 6 months. In patients with HFrEF at least 94% receive a complete scheme of 4 drugs considered pillars in the treatment of this disease, (MRA, iSGLT2, ARNI/iECA or ARA-ll and β-blocker) 6% did not tolerate this quadruple therapy mainly due to episodes of hypotension. During our first 6 months, there were no deaths due to cardiovascular causes; however, mortality due to non-cardiovascular causes was 0.8%. Rehospitalizations due to HF decompensation was 3%. Intermittent administration of levosimendan was necessary in 2% of patients to improve conditions prior to major surgical events.

Conclusion
The implementation of a HF clinic decreases mortality due to cardiovascular causes, rehospitalizations due to HF decompensation, and increases adherence to optimal treatment, follow-up, and patient self-care.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The National Institute of Medical Sciences and Nutrition Dr. Salvador Zubiran Secretary of Health of Mexico