title: An advanced chronic heart failure day care service: a 5 year single-center experience.
abstract: BACKGROUND
  Chronic heart failure is associated with excessive hospitalizations and poor prognosis.
  
  
  OBJECTIVE
  To summarize the 5 year experience of a single-center CHF day care service, detect the cardiovascular and non-cardiovascular events, and evaluate the safety of the treatments provided.
  
  
  METHODS
  We retrospectively studied all patients admitted to the CHF day care service of the Sheba Medical Center between September 2000 and September 2005.
  
  
  RESULTS
  Advanced (New York Heart Association class III-IV) CHF patients (n = 190), mean age 65 +/- 12 years and left ventricular ejection fraction 25 +/- 11%, were treated for 6 hourly biweekly visits; 77% had ischemic and 23% had nonischemic cardiomyopathy. Treatment included: intravenous diuretic combinations (91%), intermittent low dose (< or = 5 microg/kg/min) dobutamine (87%), low dose (< or = 3 microg/kg/min) dopamine (38%), intravenous iron preparation and/or blood (47%), and intravenous nitropruside (36%). Follow-up of at least 1 year from initiation of therapy was completed in 158 of 190 patients (83%). Forty-six (29.3%) died: 23% due to CHF exacerbation, 5.7% from infection, 4.4% from sudden cardiac death, 3.8% from malignancy, 2.5% from malignant arrhythmias, 1.9% from renal failure, 1.3% from stroke, and 0.6% from myocardial infarction. There were only 0.68 rehospitalizations/patient/year; the most frequent cause being CHF exacerbation (16.5%).
  
  
  CONCLUSIONS
  Our study demonstrates the safety and potential benefits of a supportive day care service for advanced CHF patients. Multidrug intravenous treatment, accompanied by monitoring of electrolytes, hemoglobin and cardiac rhythm, along with education and psychological support, appear to reduce morbidity in advanced CHF patients and may have contributed to the lower than expected mortality/ hospitalization rate.
authors.affiliation: Heart Failure Service, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Dov
authors.initials: D
authors.lastname: Freimark
authors.forename: Michael
authors.initials: M
authors.lastname: Arad
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
authors.forename: Isabell
authors.initials: I
authors.lastname: DeNeen
authors.forename: Liron
authors.initials: L
authors.lastname: Gershovitz
authors.forename: Nira Koren
authors.initials: NK
authors.lastname: Morag
authors.forename: Naomi
authors.initials: N
authors.lastname: Hochberg
authors.forename: Yafit
authors.initials: Y
authors.lastname: Makmal
authors.forename: Michael
authors.initials: M
authors.lastname: Shechter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration*; D003631:Day Care, Medical / Q000458:organization & administration*; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies