title: Clinical outcome of patients with chronic heart failure followed in a specialized heart failure center.
abstract: BACKGROUND
  Patients with heart failure (HF) have a poor prognosis. Heart failure centers with specialized nurse-supervised management programs have been proposed to improve prognosis.
  
  
  OBJECTIVE
  To evaluate the clinical outcome of patients with HF treated at a multidisciplinary HF center of Clalit Health Services in Jerusalem in collaboration with Hadassah University Hospital.
  
  
  METHODS
  We evaluated clinical outcome including hospitalizations and death in all HF patients followed at the HF center for 1 year.
  
  
  RESULTS
  Altogether, 324 patients were included and followed at the HF center; 58% were males with a mean age of 76 +/- 11 years, and 58% were in New York Heart Association (NYHA) functional class Ill-IV. The overall 1 year survival rate was 91% and the 1 year hospitalization rate 29%. Comparing patients in the HF center to the whole cohort of patients with a diagnosis of HF (N = 6618) in Clalit Health Services in Jerusalem demonstrated a similar 1 year survival rate: 91% vs. 89% respectively but with a significantly reduced hospitalization rate: 29% vs. 42% respectively (P < 0.01). Cox regression analysis demonstrated that treatment in the HF center was a significant predictor of reduced hospitalization after adjustment for other predictors (hazard ratio 0.65, 95% confidence interval 0.53-0.80, P < 0.0001). A subset of patients that was evaluated (N = 78) showed significantly increased compliance. NYHA class improved in these patients from a mean of 3.1 +/- 0.1 to 2.6 +/- 0.1 after treatment (P < 0.0001).
  
  
  CONCLUSIONS
  Supervision by dedicated specialized nurses in a HF center increased compliance, improved functional capacity in HF patients, and reduced hospitalization rate. HF centers should be considered part of the standard treatment of patients with symptomatic HF.
authors.affiliation: Heart Institute, Hadassah University Hospital, Jerusalem, Israel. igotsman@bezeqint.net
authors.forename: Israel
authors.initials: I
authors.lastname: Gotsman
authors.forename: Donna
authors.initials: D
authors.lastname: Zwas
authors.forename: Zehava
authors.initials: Z
authors.lastname: Zemora
authors.forename: Refat
authors.initials: R
authors.lastname: Jabara
authors.forename: Dan
authors.initials: D
authors.lastname: Admon
authors.forename: Chaim
authors.initials: C
authors.lastname: Lotan
authors.forename: Andre
authors.initials: A
authors.lastname: Keren
mesh_terms: D000368:Aged; D002300:Cardiac Care Facilities / Q000458:organization & administration*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003266:Continuity of Patient Care; D003376:Counseling; D004032:Diet; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000401:mortality* / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel; D008297:Male; D009741:Nursing Staff, Hospital; D010348:Patient Care Team; D010349:Patient Compliance; D012044:Regression Analysis; D012648:Self Care
chemical_list: D002316:Cardiotonic Agents