“Last year we worked with many other colleagues at the Hta (Health Technology Assessment) process on heart failure in the Marche region. An exciting experience. Being able to re-evaluate and analyze how much new in terms of medical therapy, organization, device has developed around the patient with heart failure in the world in recent years, is very educational. HTA should be a permanent and ever-changing program. Starting from the stimulus that the initiative has generated and from its publication, together with colleagues with whom we share a passion for work and a desire for improvement, we have followed up on this commitment, trying to structure a ‘network for advanced heart failure’ “. Marco Marini and Ilaria Battistoni, cardiologists of the cardiological intensive care unit of the Ospedali Riuniti of Ancona in an editorial published on Allies for Health, the portal dedicated to medical-scientific information created by Novartis.
Patients with advanced heart failure, “despite being a minority of decompensated patients, are the most serious and absorb the greatest ‘technological expenditure’ – write the two clinicians – Are the patients who may be candidates for heart transplantation orif the latter is contraindicated (due to advanced age or comorbidities), to advanced therapies such as Lvad (Left ventricular assistence device), mitral-clip or for example ablations of complex ventricular arrhythmias. In any case, all these therapies require careful evaluation and must be proposed and performed in a very precise “disease timing”, because the risk of futility is very high “.
“All the representatives of the cardiologies of the Marche region (in some cases more than one representative) and also of some extra-regional cardiologies (Abruzzo and Umbria) that deal with heart failure in their respective structures – explain Marini and Battistoni – were invited to a work table where we started sharing selection and co-management criteria between Spoke centers and Hub centers. The only Hub hospital able to provide these patients with all the existing therapeutic options (except for heart transplantation for which there is a shared program with transplant centers of northern italic transplantation) in the Marche region is the Aou Ospedali Riuniti in Ancona. and therefore, to obviate the risk of overcrowding on the one hand and a therapeutic delay on the other, it was necessary to set up a multidisciplinary evaluation process involving the treating cardiologist, the cardiologist expert in heart failure, the cardiologist intensivist, the heart surgeon , the hemodynamist, the cardioanesthetist “.
“We shared many aspects – recall the two cardiologists – from the patient’s reference method (through dedicated email channels rather than telephone numbers), to which diagnostic tests represent the“ minimal data set ”that a Spoke center must provide to the Hub center. Similarly, there was an agreement on the type of follow-up that some patients need to do in their referral hospital rather than in the Hub center to which they are referred. The experience generated three fundamental responses: it formalized an effective network from an operational point of view; harmonized a group of professionals in the management of extremely complex patients; indirectly provided the patient with advanced heart failure an optimal diagnosis and treatment process regardless of the municipality or province of residence. After these meetings (3 times in 3 midweek afternoons on a monthly basis) we parted ways, proposing new opportunities for the current year, with the intention of reviewing what has already been created, revising the process and trying to optimize it through analysis of specific cases and of the entire treatment process “, they conclude.
The complete article is available on: https://www.alleatiperlasalute.it/il-dialogo-conta/scompenso-cardiaco-nelle-marche-un-percorso-multidisciplinare-basato-sulleseaven