[Cardiovascular medicine unit: preliminary results of an in-hospital multidisciplinary intervention in heart failure].
BACKGROUND
In Italy the majority of patients with heart failure are admitted to Internal Medicine Divisions, where diagnostic and therapeutic procedures, suggested by guidelines, are less utilized than in Cardiology Divisions. In order to provide a better assistance to patients with heart failure, a Cardiovascular Medicine Unit was founded with interdepartmental valence (Cardiovascular and Internal Medicine) in the "Ospedali Riuniti" Hospital of Bergamo. The purpose of this study was to evaluate the preliminary results, concerning management of heart failure, in the first 6 months of activities carried out at the Cardiovascular Medicine Unit and to compare them with those of other structures that usually manage this disease.


METHODS
Analysis of data concerning 150 admissions to the Cardiovascular Medicine Unit for heart failure in 147 patients during the first 6 months of 2003. Comparisons of admittance data for heart failure in the first semester 2001 deriving from the Internal Medicine Division of the "Ospedali Riuniti" Hospital of Bergamo, the TEMISTOCLE study and the Niguarda Ca' Granda Hospital of Milan.


RESULTS
A higher prescription of beta-blockers and spironolactone was observed in the Cardiovascular Medicine Unit than in other structures (p < 0.001). Echocardiography and coronary angiography were performed more frequently (p < 0.001) and the number of rehospitalizations was lower for all cases (p < 0.05) as well as for heart failure (p < 0.001). The extensive use of diagnostic procedures and multidisciplinary evaluation of co-morbidities allowed to identify patients who could be managed successfully with surgical therapy; preliminary data suggest a net benefit in terms of NYHA functional class and reduction in rehospitalization in this subgroup of patients.


CONCLUSIONS
These data demonstrate that the Cardiovascular Medicine model, based on integration of knowledge between cardiologists and internists, is effective with respect to organization and assistance and allows to optimize heart failure patient management.
Senni
Michele
M
Dipartimento Cardiovascolare, Ospedali Riuniti, Bergamo. msenni@ospedaliriuniti.bergamo.it
Gori
Mauro
M
Alari
Gabriella
G
Duino
Vincenzo
V
Siccardo
Raffaella
R
Grosu
Aurelia
A
Santilli
Giovanna
G
Parrella
Piervirgilio
P
Saronni
Patrizia
P
Pezzoli
Fabio
F
Migliori
Maurizio
M
Minetti
Bruno
B
Suter
Fredy
F
De Maria
Renata
R
Ferrazzi
Paolo
P
Gavazzi
Antonello
A
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003325:Coronary Care Units / Q000592:standards; D003627:Data Interpretation, Statistical; D004232:Diuretics / Q000627:therapeutic use; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D016011:Normal Distribution; D010343:Patient Admission; D010359:Patient Readmission; D013148:Spironolactone / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone