title: [The APULIA HF multicenter study: efficacy of a management protocol shared between hospital and territorial health services for acute decompensated heart failure patients].
abstract: BACKGROUND
  The aim of this study was to demonstrate the efficacy of a management model to reduce hospitalizations in patients recently admitted for acute decompensated heart failure.
  
  
  METHODS
  The management model was based on a close integration between hospital and territory health services. Clinical evaluation, ECG, echocardiographic findings, total body bioimpedance and brain natriuretic peptide serum levels were used to assess clinical stability of patients at discharge and during follow-up. A dedicated nurse (care manager) was involved in patient empowerment, telephone follow-up, check of adherence to therapy and clinical conditions, and management of scheduled evaluations. All hospitalizations occurring prior to or after enrolment in the municipalities involved in the study were considered, as well as the hospitalizations occurring among enrolled patients.
  
  
  RESULTS
  A total of 301 patients were enrolled, 226 of them from the Centers of the Puglia Region, Italy. An overall reduction of 6% in total hospitalizations with DRG 127 was observed; the reduction was most evident in the two centers with the smaller reference population (-16% and -26%, respectively). In the group of patients enrolled, an overall reduction in hospital admissions was observed after comparing the period before and after enrolment. A significant increase in the prescription rate of angiotensin-converting enzyme inhibitor/angiotensin receptor blockers, beta-blockers and aldosterone antagonists was also observed. Finally, an overall reduction in the costs for patient management was demonstrated. Similar results were obtained in the two additional Centers of the Basilicata and Lazio Regions.
  
  
  CONCLUSIONS
  An integrated management between hospital and territory allows optimization of the management of heart failure patients, with improvement of therapy and reduction in hospitalizations and management costs.
authors.affiliation: U.O. Cardiologia Universitaria, AOU Policlinico Consorziale, Bari.
authors.forename: Massimo
authors.initials: M
authors.lastname: Iacoviello
authors.affiliation: Distretto Socio-Sanitario 1 Brindisi, ASL Brindisi.
authors.forename: Sergio
authors.initials: S
authors.lastname: Pede
authors.affiliation: U.O.C. Cardiologia-UTIC, Presidio Ospedaliero San Filippo Neri, Roma.
authors.forename: Nadia
authors.initials: N
authors.lastname: Aspromonte
authors.affiliation: U.O.C. Cardiologia, Ospedale Di Venere, Bari.
authors.forename: Francesca
authors.initials: F
authors.lastname: Bux
authors.affiliation: U.O.C. Cardiologia, ASL BAT, Bisceglie (BT).
authors.forename: Mariligia
authors.initials: M
authors.lastname: Panunzio
authors.affiliation: U.O.C. Cardiologia, Ospedale San Paolo, Bari.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Donadeo
authors.affiliation: UOC Cardiologia, Ospedale Perrino, Brindisi.
authors.forename: Alessandra
authors.initials: A
authors.lastname: De Castro
authors.affiliation: ASL BA, Bari.
authors.forename: Ettore
authors.initials: E
authors.lastname: Antoncecchi
authors.affiliation: U.O.C. Cardiologia, Ospedale Di Venere, Bari.
authors.forename: Nicola
authors.initials: N
authors.lastname: D'Amato
authors.affiliation: ASL BA, Bari.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Squiccimarro
authors.affiliation: ASL MT, Matera.
authors.forename: Bartolomeo
authors.initials: B
authors.lastname: Silvestri
authors.affiliation: U.O.C. Cardiologia, ASL BAT, Bisceglie (BT).
authors.forename: Lucia
authors.initials: L
authors.lastname: Malerba
authors.affiliation: U.O.C. Cardiologia, Ospedale San Paolo, Bari.
authors.forename: Luisa
authors.initials: L
authors.lastname: De Gennaro
authors.affiliation: U.O.C. Cardiologia, ASL BAT, Bisceglie (BT).
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Modugno
authors.affiliation: Poliambulatorio S. Maria della Pietà, Distretto 19, ASL Roma 1, Roma.
authors.forename: Elena
authors.initials: E
authors.lastname: Serafini
authors.affiliation: ASL BAT, Trani (BT).
authors.forename: Biagio
authors.initials: B
authors.lastname: Curci
authors.affiliation: U.O. Cardiologia Universitaria, AOU Policlinico Consorziale, Bari.
authors.forename: Dario
authors.initials: D
authors.lastname: Grande
authors.affiliation: U.O.C. Cardiologia-UTIC, Presidio Ospedaliero San Filippo Neri, Roma.
authors.forename: Furio
authors.initials: F
authors.lastname: Colivicchi
authors.affiliation: U.O.C. Cardiologia, ASL BAT, Bisceglie (BT).
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Luca
authors.affiliation: UOC Cardiologia, Ospedale Perrino, Brindisi.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Ignone
authors.affiliation: U.O.C. Cardiologia, Ospedale Di Venere, Bari.
authors.forename: Carlo
authors.initials: C
authors.lastname: D'Agostino
authors.affiliation: U.O.C. Cardiologia, Ospedale San Paolo, Bari.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Caldarola
mesh_terms: D000208:Acute Disease; D000368:Aged; D002985:Clinical Protocols; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008297:Male